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Medicare Physician Fee Schedule · Q3 2026 release

CPT 69210 in Riverside, CA 01112-62

Impacted earwax removal in ZIPs including 92501, 92401, and 91761

69210 2026 C · Riverside, CA flag01112-62 A Active
Allowed amount
$50.24
in a doctor’s own office or clinic

105.2% of the $47.76 national baseline

Medicare payment
$40.19
Patient / secondary
$10.05
Expected total to provider
$50.24

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 69210 in Riverside, CA? Copy link

The Medicare allowed amount is $50.24 in the office (non-facility) setting and $27.55 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 5.2% above the national baseline, and the facility amount is 1.8% 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 Riverside, CA in? Copy link

CMS payment locality Riverside-San Bernardino-Ontario. The same amount applies across the whole locality, including San Bernardino and Ontario.

Why Riverside, CA differs from the national amount Copy link

Riverside, CA (this locality)
$50.24
National PFS baseline (GPCI 1.000)
$47.76

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 Riverside, CA at 5.2% above the national baseline.

Work GPCI
1.018
Practice expense GPCI
1.096
Malpractice GPCI
0.853
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 69210 in Riverside, CA: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Riverside, CA allowed amount for 69210
Component RVU × GPCI = Adjusted RVU
Work 0.59 1.018 0.6006
Practice expense 0.77 1.096 0.8439
Malpractice 0.07 0.853 0.0597
Sum of adjusted RVUs 1.5042
× $33.4009 2026 conversion factor $50.24

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Riverside, CA allows $27.55 for 69210, versus $50.24 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 Riverside, CA. 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 69210 in Riverside, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $50.24
Non-participating allowed amount 95% of the participating amount. $47.73
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $54.89
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $40.19
Beneficiary coinsurance The remaining 20%. $10.05
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $0.80
Medicare pays after sequestration Program payment net of the sequestration reduction. $39.39

Contracted rate: % of Medicare in Riverside, CA 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 — $50.24 in the office (non-facility) setting — not the $47.76 national baseline.

Opens the calculator already set to Riverside, CA 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 Riverside, CA rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality. 69210 prices identically in every one of them. 3 of them span more than one locality and need ZIP+4 for an exact match.

91701 91708 91709 91710 91718 91719 91720 91729 91730 91737 91739 91743 91752 91758 91759 91760 91761 91762 91763 91764 91784 91785 91786 91798 92201 92202 92203 92210 92211 92220 92223 92225 92226 92230 92234 92235 92236 92239 92240 92241 92242 92247 92248 92252 92253 92254 92255 92256 92258 92260 92261 92262 92263 92264 92267 92268 92270 92274 92276 92277 92278 92280 92282 92284 92285 92286 92292 92301 92304 92305 92307 92308 92309 92310 92311 92312 92313 92314 92315 92316 92317 92318 92320 92321 92322 92323 92324 92325 92326 92327 92329 92331 92332 92333 92334 92335 92336 92337 92338 92339

128 more ZIP codes map to this locality. The Riverside, CA locality page lists the full set.

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

69210 in nearby payment localities Copy link

Payment localities in the same region as Riverside, CA, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 69210. Proximity doesn't imply similar pricing — neighbouring localities often differ.

69210 allowed amount in payment localities near Riverside, CA
Metro Allowed amount vs. Riverside, CA
Los Angeles, CA $52.49 +4.5%
San Diego, CA $52.32 +4.1%
Ventura County, CA $52.11 +3.7%
Bakersfield, CA $49.69 -1.1%
Las Vegas, NV $47.40 -5.7%
Phoenix, AZ $46.63 -7.2%

Every payment locality nationwide is on the CPT 69210 rate map.

Other codes priced in Riverside, CA Copy link

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

Other curated codes and their allowed amounts in Riverside, CA
Code Service Riverside, CA vs. national
31231 Diagnostic Nasal Endoscopy $207.87 +7.5%
69436 Ear, nose and throat $151.13 +4.5%
42820 Ear, nose and throat $270.41 +3.7%
99213 Routine Follow-Up Office Visit $100.21 +5.3%
99214 Long Follow-Up Office Visit $142.49 +5.1%
66984 Cataract Surgery $483.95 +4.6%
92014 Full Eye Exam, Returning Patient $135.45 +6.4%
99204 Long New Patient Office Visit $185.66 +4.7%
99212 Brief Follow-Up Office Visit $62.85 +5.7%
99215 Longest Follow-Up Office Visit $201.86 +4.9%
97110 Physical Therapy Exercises $30.59 +5.3%
99203 New Patient Office Visit $123.39 +5.0%

Common questions Copy link

Which ZIP codes does the Riverside, CA rate for 69210 cover?
The CMS ZIP-to-locality crosswalk maps 228 ZIP codes to this payment locality, and every one of them prices 69210 identically. Examples include 91701, 91708, 91709, 91710, 91718, 91719. 3 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 69210 rate in Riverside, CA 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 1.096, malpractice 0.853 — scale each RVU component before the conversion factor is applied, which is why Riverside, CA allows more than the $47.76 baseline.
Which cities does the Riverside, CA rate for 69210 cover?
This payment locality also covers San Bernardino and Ontario. Every location in it prices 69210 identically — the label names the largest metro, not a city-specific amount.
What is the facility rate for 69210 in Riverside, CA?
$27.55 in a facility, versus $50.24 in the office (non-facility) setting — a $22.69 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 69210 in Riverside, CA?
A non-participating provider is paid $47.73 — 95% of the $50.24 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $54.89, which is 115% of the non-participating amount.
How much of the Riverside, CA 69210 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($40.19) once the annual Part B deductible is met, and the beneficiary owes 20% ($10.05). Sequestration reduces Medicare's share by about 2% ($0.80), leaving $39.39. 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 01112-62'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 7,535)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 20)
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 69210 in Riverside, CA against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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