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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in Providence, RI 14412-01

Open carpal tunnel release in ZIPs including 02903, 02840, and 02886

64721 2026 C · Providence, RI flag14412-01 A Active
Allowed amount
$491.64
in a doctor’s own office or clinic

101.9% of the $482.64 national baseline

Medicare payment
$393.31
Patient / secondary
$98.33
Expected total to provider
$491.64

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 64721 in Providence, RI? Copy link

The Medicare allowed amount is $491.64 in the office (non-facility) setting and $430.22 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 1.9% above the national baseline, and the facility amount is 1.7% above the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Providence, RI in? Copy link

CMS prices all of Rhode Island as one Medicare payment locality, so this amount applies statewide, including Warwick, Cranston and Pawtucket — not only in Providence, RI.

Why Providence, RI differs from the national amount Copy link

Providence, RI (this locality)
$491.64
National PFS baseline (GPCI 1.000)
$482.64

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Providence, RI at 1.9% above the national baseline.

Work GPCI
1.019
Practice expense GPCI
1.033
Malpractice GPCI
0.892
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 64721 in Providence, RI: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Providence, RI allowed amount for 64721
Component RVU × GPCI = Adjusted RVU
Work 4.85 1.019 4.9421
Practice expense 8.61 1.033 8.8941
Malpractice 0.99 0.892 0.8831
Sum of adjusted RVUs 14.7194
× $33.4009 2026 conversion factor $491.64

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Providence, RI allows $430.22 for 64721, versus $491.64 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Providence, RI. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 64721 in Providence, RI
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $491.64
Non-participating allowed amount 95% of the participating amount. $467.06
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $537.12
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $393.31
Beneficiary coinsurance The remaining 20%. $98.33
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $7.87
Medicare pays after sequestration Program payment net of the sequestration reduction. $385.44

Contracted rate: % of Medicare in Providence, RI Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $491.64 in the office (non-facility) setting — not the $482.64 national baseline.

Opens the calculator already set to Providence, RI and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Providence, RI rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 91 ZIP codes to this payment locality. 64721 prices identically in every one of them.

02801 02802 02804 02806 02807 02808 02809 02812 02813 02814 02815 02816 02817 02818 02822 02823 02824 02825 02826 02827 02828 02829 02830 02831 02832 02833 02835 02836 02837 02838 02839 02840 02841 02842 02852 02854 02857 02858 02859 02860 02861 02862 02863 02864 02865 02871 02872 02873 02874 02875 02876 02877 02878 02879 02880 02881 02882 02883 02885 02886 02887 02888 02889 02891 02892 02893 02894 02895 02896 02898 02901 02902 02903 02904 02905 02906 02907 02908 02909 02910 02911 02912 02914 02915 02916 02917 02918 02919 02920 02921 02940

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

64721 in nearby payment localities Copy link

Payment localities in the same region as Providence, RI, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 64721. Proximity doesn't imply similar pricing — neighbouring localities often differ.

64721 allowed amount in payment localities near Providence, RI
Metro Allowed amount vs. Providence, RI
Boston, MA $541.44 +10.1%
Hartford, CT $514.97 +4.7%
Portland, ME $467.85 -4.8%
New York City, NY $558.98 +13.7%
Long Island, NY $575.70 +17.1%
Philadelphia, PA $503.73 +2.5%

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

Other codes priced in Providence, RI Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Providence, RI
Code Service Providence, RI vs. national
66984 Cataract Surgery $471.97 +2.0%
27447 Knee Replacement $1,169.74 +0.9%
66982 Complex Cataract Surgery With Lens Implant $643.03 +2.0%
27130 Total Hip Arthroplasty $1,172.35 +0.9%
29827 Arthroscopic Rotator Cuff Repair $987.05 +1.1%
47562 Outpatient surgery $635.45 +0.6%
29881 Outpatient surgery $522.93 +1.4%
23472 Total Shoulder Arthroplasty $1,312.58 +0.9%
49505 Outpatient surgery $511.51 +0.7%
58571 Outpatient surgery $835.19 +0.8%
19120 Outpatient surgery $582.55 +1.6%
43775 Outpatient surgery $998.96 -0.1%

Common questions Copy link

Which ZIP codes does the Providence, RI rate for 64721 cover?
The CMS ZIP-to-locality crosswalk maps 91 ZIP codes to this payment locality, and every one of them prices 64721 identically. Examples include 02801, 02802, 02804, 02806, 02807, 02808.
Why is the 64721 rate in Providence, RI 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 1.019, practice expense 1.033, malpractice 0.892 — scale each RVU component before the conversion factor is applied, which is why Providence, RI allows more than the $482.64 baseline.
Does this 64721 rate apply everywhere in Rhode Island?
Yes. CMS prices Rhode Island as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Providence, RI. That includes Warwick, Cranston and Pawtucket. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.
What is the facility rate for 64721 in Providence, RI?
$430.22 in a facility, versus $491.64 in the office (non-facility) setting — a $61.42 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 64721 in Providence, RI?
A non-participating provider is paid $467.06 — 95% of the $491.64 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $537.12, which is 115% of the non-participating amount.
How much of the Providence, RI 64721 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($393.31) once the annual Part B deductible is met, and the beneficiary owes 20% ($98.33). Sequestration reduces Medicare's share by about 2% ($7.87), leaving $385.44. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 14412-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 7,150)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 92)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 64721 in Providence, RI against the release that governed that date. Past releases need a free account; today's rate does not.

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