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Medicare Physician Fee Schedule · Q4 2026 release

CPT 64721 in Philadelphia, PA

Open carpal tunnel release in ZIPs including 19102, 19103, and 19106

64721 Q4 2026 · Philadelphia, PA flag12502-01
Locality-adjusted allowed amount
$503.73
in a doctor’s own office or clinic

104.4% of the $482.64 national baseline

( Work4.85 × 1.018 + Practice exp.8.61 × 1.041 + Malpractice0.99 × 1.193 ) × Conv. factor$33.4009 = $503.73

The Medicare allowed amount is $503.73 in the Office (non-facility) setting and $441.84 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

Q4 2026 · Locality 12502-01 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Philadelphia, PA in? Copy link

Philadelphia, PA is in CMS payment locality Metropolitan Philadelphia (12502-01). The same amount applies everywhere in it.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (363)

The CMS ZIP-to-locality crosswalk maps 363 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 11 span more than one locality and need ZIP+4 for an exact match.

18039 18041 18054 18070 18073 18074 18076 18077 18081 18084 18901 18902 18910 18911 18912 18913 18914 18915 18916 18917 18918 18920 18921 18922 18923 18924 18925 18926 18927 18928 18929 18930 18931 18932 18933 18934 18935 18936 18938 18940 18942 18943 18944 18946 18947 18949 18950 18951 18953 18954 18955 18956 18957 18958 18960 18962 18963 18964 18966 18968 18969 18970 18971 18972 18974 18976 18977 18979 18980 18981 18991 19001 19002 19003 19004 19006 19007 19008 19009 19010 19012 19013 19014 19015 19016 19017 19018 19019 19020 19021 19022 19023 19025 19026 19027 19028 19029 19030 19031 19032

263 more ZIP codes map to this locality. The Philadelphia, PA locality page lists the full set.

Which ZIP codes does the Philadelphia, PA rate for 64721 cover?

The CMS ZIP-to-locality crosswalk maps 363 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 18039, 18041, 18054, 18070, 18073, 18074. Of these, 11 span more than one payment locality and need ZIP+4 for an exact match.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Philadelphia, PA (this locality)
$503.73
National PFS baseline (GPCI 1.000)
$482.64

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Philadelphia, PA 4.4% above the national baseline.

Work GPCI
1.018
Practice expense GPCI
1.041
Malpractice GPCI
1.193
2026 conversion factor
$33.4009
Why is the 64721 rate in Philadelphia, PA different from the national amount?

The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices—work 1.018, practice expense 1.041, malpractice 1.193—scale each RVU component before the conversion factor is applied, which is why the Philadelphia, PA amount is higher than the $482.64 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 64721's RVU components is multiplied by its Philadelphia, PA GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
METROPOLITAN PHILADELPHIA (PA)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of Philadelphia, PA allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.018 4.9373
Practice expense · Office (non-facility) 8.61 × 1.041 8.9630
Malpractice 0.99 × 1.193 1.1811
Sum of adjusted RVUs 15.0814
× 33.4009 conversion factor = formula amount $503.73

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $503.73

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • Supplies the RVUs and PFS status for this code and component.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 7,210)
    hcpcs (col 1)
    64721
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    4.85
    pe_rvu_nonfacility (col 7)
    8.61
    pe_rvu_facility (col 9)
    6.83
    mp_rvu (col 11)
    0.99

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details GPCI2026.csv in rvu26d-updated-08-26-2026.zip (row 89)
    mac (col 1)
    12502
    locality_code (col 3)
    01
    work_gpci (col 5)
    1.018
    pe_gpci (col 6)
    1.041
    mp_gpci (col 7)
    1.193

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 64721 in Philadelphia, PA is $441.84, versus $503.73 in the Office (non-facility) setting. Only the practice-expense RVU changes with the setting: the facility bills its own fee for overhead, so the professional amount is lower. See which setting applies to your place of service.

What is the Facility amount for 64721 in Philadelphia, PA?

$441.84 in a facility, versus $503.73 in the Office (non-facility) setting—a $61.89 difference. Only the practice-expense RVU changes with the setting: in the Office (non-facility) setting the practice carries the overhead, so the professional amount is higher; in a hospital or ASC the facility bills its own fee.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Philadelphia, PA. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 64721 in Philadelphia, PA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $503.73
Non-participating allowed amount 95% of the participating amount. $478.54
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $550.32
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $402.98
Patient coinsurance The remaining 20%. $100.75
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $8.06
Net Medicare payment Medicare's share after the sequestration reduction. $394.92
What is the non-participating amount and limiting charge for 64721 in Philadelphia, PA?

A non-participating provider is paid $478.54—95% of the $503.73 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $550.32, which is 115% of the non-participating amount.

How much of the Philadelphia, PA 64721 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($402.98) once the annual Part B deductible is met, and the beneficiary owes 20% ($100.75). Sequestration reduces Medicare's share by about 2% ($8.06), leaving $394.92. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Philadelphia, PA Copy link

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$503.73 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to Philadelphia, PA and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

Compare 64721 in nearby payment localities

Payment localities in the same region as Philadelphia, PA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 64721. Neighboring localities often differ.

64721 allowed amount in payment localities near Philadelphia, PA
Metro Allowed amount vs. Philadelphia, PA
Northern New Jersey, NJ $541.11 +7.4%
Baltimore, MD $514.07 +2.1%
New York City, NY $558.98 +11.0%
Washington, DC $546.32 +8.5%
Pittsburgh, PA $457.24 -9.2%
Queens, NY $559.97 +11.2%

Every payment locality nationwide is on the CPT 64721 rate map.

Other codes priced in Philadelphia, PA Copy link

Office (non-facility) allowed amounts in this same payment locality, Q4 2026.

Other curated codes and their allowed amounts in Philadelphia, PA
Code and service Allowed vs. national
66984 Cataract Surgery $478.80 +3.5%
27447 Knee Replacement $1,212.61 +4.6%
66982 Complex Cataract Surgery With Lens Implant $652.80 +3.5%
27130 Total Hip Arthroplasty $1,215.54 +4.6%
29827 Arthroscopic Rotator Cuff Repair $1,020.14 +4.5%
47562 Outpatient surgery $663.57 +5.0%
29881 Outpatient surgery $538.70 +4.5%
23472 Total Shoulder Arthroplasty $1,359.17 +4.5%
49505 Outpatient surgery $533.30 +5.0%
58571 Outpatient surgery $866.49 +4.6%
19120 Outpatient surgery $599.59 +4.6%
43775 Outpatient surgery $1,052.46 +5.2%

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 12502-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 7,210)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 89)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices 64721 in Philadelphia, PA against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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