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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in Houston, TX 04412-18

Open carpal tunnel release in ZIPs including 77002, 77019, and 77024

64721 2026 C · Houston, TX flag04412-18 A Active
Allowed amount
$494.36
in a doctor’s own office or clinic

102.4% of the $482.64 national baseline

Medicare payment
$395.49
Patient / secondary
$98.87
Expected total to provider
$494.36

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 Houston, TX? Copy link

The Medicare allowed amount is $494.36 in the office (non-facility) setting and $435.32 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 2.4% above the national baseline, and the facility amount is 2.9% 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 Houston, TX in? Copy link

CMS payment locality Houston (04412-18). Every location in it is priced identically.

Why Houston, TX differs from the national amount Copy link

Houston, TX (this locality)
$494.36
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 Houston, TX at 2.4% above the national baseline.

Work GPCI
1.008
Practice expense GPCI
0.993
Malpractice GPCI
1.376
2026 conversion factor
$33.4009

Formula and inputs Copy link

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

RVU and GPCI components of the Houston, TX allowed amount for 64721
Component RVU × GPCI = Adjusted RVU
Work 4.85 1.008 4.8888
Practice expense 8.61 0.993 8.5497
Malpractice 0.99 1.376 1.3622
Sum of adjusted RVUs 14.8008
× $33.4009 2026 conversion factor $494.36

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Houston, TX allows $435.32 for 64721, versus $494.36 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 Houston, TX. 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 Houston, TX
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $494.36
Non-participating allowed amount 95% of the participating amount. $469.64
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $540.09
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $395.49
Beneficiary coinsurance The remaining 20%. $98.87
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $7.91
Medicare pays after sequestration Program payment net of the sequestration reduction. $387.58

Contracted rate: % of Medicare in Houston, TX 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 — $494.36 in the office (non-facility) setting — not the $482.64 national baseline.

Opens the calculator already set to Houston, TX 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 Houston, TX rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 243 ZIP codes to this payment locality. 64721 prices identically in every one of them. 12 of them span more than one locality and need ZIP+4 for an exact match.

77001 77002 77003 77004 77005 77006 77007 77008 77009 77010 77011 77012 77013 77014 77015 77016 77017 77018 77019 77020 77021 77022 77023 77024 77025 77026 77027 77028 77029 77030 77031 77032 77033 77034 77035 77036 77037 77038 77039 77040 77041 77042 77043 77044 77045 77046 77047 77048 77049 77050 77051 77052 77054 77055 77056 77057 77058 77059 77060 77061 77062 77063 77064 77065 77066 77067 77068 77069 77070 77071 77072 77073 77074 77075 77076 77077 77078 77079 77080 77081 77082 77083 77084 77085 77086 77087 77088 77089 77090 77091 77092 77093 77094 77095 77096 77097 77098 77099 77201 77202

143 more ZIP codes map to this locality. The Houston, TX locality page lists the full set.

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 Houston, TX, 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 Houston, TX
Metro Allowed amount vs. Houston, TX
San Antonio, TX $464.77 -6.0%
Austin, TX $495.88 +0.3%
Dallas, TX $478.26 -3.3%
Fort Worth, TX $475.81 -3.8%
New Orleans, LA $470.17 -4.9%
Oklahoma City, OK $444.50 -10.1%

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

Other codes priced in Houston, TX Copy link

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

Other curated codes and their allowed amounts in Houston, TX
Code Service Houston, TX vs. national
66984 Cataract Surgery $469.86 +1.6%
27447 Knee Replacement $1,212.23 +4.6%
66982 Complex Cataract Surgery With Lens Implant $641.31 +1.7%
27130 Total Hip Arthroplasty $1,215.27 +4.6%
29827 Arthroscopic Rotator Cuff Repair $1,016.11 +4.1%
47562 Outpatient surgery $666.79 +5.5%
29881 Outpatient surgery $533.44 +3.4%
23472 Total Shoulder Arthroplasty $1,357.78 +4.4%
49505 Outpatient surgery $534.58 +5.2%
58571 Outpatient surgery $868.20 +4.8%
19120 Outpatient surgery $590.59 +3.0%
43775 Outpatient surgery $1,070.27 +7.0%

Common questions Copy link

Which ZIP codes does the Houston, TX rate for 64721 cover?
The CMS ZIP-to-locality crosswalk maps 243 ZIP codes to this payment locality, and every one of them prices 64721 identically. Examples include 77001, 77002, 77003, 77004, 77005, 77006. 12 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 64721 rate in Houston, TX 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 1.008, practice expense 0.993, malpractice 1.376 — scale each RVU component before the conversion factor is applied, which is why Houston, TX allows more than the $482.64 baseline.
What is the facility rate for 64721 in Houston, TX?
$435.32 in a facility, versus $494.36 in the office (non-facility) setting — a $59.04 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 Houston, TX?
A non-participating provider is paid $469.64 — 95% of the $494.36 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $540.09, which is 115% of the non-participating amount.
How much of the Houston, TX 64721 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($395.49) once the annual Part B deductible is met, and the beneficiary owes 20% ($98.87). Sequestration reduces Medicare's share by about 2% ($7.91), leaving $387.58. 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 04412-18'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 102)
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 Houston, TX against the release that governed that date. Past releases need a free account; today's rate does not.

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