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Medicare Physician Fee Schedule Effective Locality 04412-31 CMS RVU26D Updated

CPT 69210 Medicare rate in Austin, TX

Impacted earwax removal in ZIPs including 78701, 78704, and 78731

The Medicare allowed amount is $49.03 in the Office (non-facility) setting and $27.12 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.

69210 Q4 2026
Locality-adjusted allowed amount
$49.03
in a doctor’s own office or clinic

Austin, TX flag Austin, TX (Locality 04412-31)

2.7% above the national baseline ($47.76)

CMS RVU26DOctober 1 – December 31, 2026revision 2

( Work0.59 × 1.002 + Practice exp.0.77 × 1.058 + Malpractice0.07 × 0.886 ) × Conv. factor$33.4009 = $49.03

row 7,595

F Work RVU

0.59

G Non‑facility PE RVU

0.77

K MP RVU

0.07

Z Conversion factor

33.4009

row 96

E Work GPCI

1.002

F PE GPCI

1.058

G MP GPCI

0.886

The Medicare allowed amount is $49.03 in the Office (non-facility) setting and $27.12 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.

Assumes a participating provider, no modifiers, the whole service, before sequestration.

Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method

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What Medicare locality is Austin, TX in? Copy link

Austin, TX is in CMS payment locality Austin (04412-31). 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 (89)

The CMS ZIP-to-locality crosswalk maps 89 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 12 span more than one locality and need ZIP+4 for an exact match.

73301 73344 78617 78645 78651 78652 78653 78660 78669 78691 78701 78702 78703 78704 78705 78708 78709 78710 78711 78712 78713 78714 78715 78716 78718 78719 78720 78721 78722 78723 78724 78725 78726 78727 78728 78730 78731 78732 78733 78734 78735 78736 78738 78739 78741 78742 78744 78745 78746 78747 78748 78749 78750 78751 78752 78753 78754 78755 78756 78757 78758 78759 78760 78761 78762 78763 78764 78765 78766 78767 78768 78769 78771 78772 78773 78774 78778 78779 78780 78781 78782 78783 78785 78786 78787 78788 78789 78798 78799
Which ZIP codes does the Austin, TX rate for 69210 cover?

The CMS ZIP-to-locality crosswalk maps 89 ZIP codes to this payment locality, and 69210 has the same amount in every one of them. Examples include 73301, 73344, 78617, 78645, 78651, 78652. Of these, 12 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

Austin, TX (this locality)
$49.03
National PFS baseline (GPCI 1.000)
$47.76

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Austin, TX 2.7% above the national baseline.

Work GPCI
1.002
Practice expense GPCI
1.058
Malpractice GPCI
0.886
2026 conversion factor
$33.4009

CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows

Why is the 69210 rate in Austin, 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 1.002, practice expense 1.058, malpractice 0.886—scale each RVU component before the conversion factor is applied, which is why the Austin, TX amount is higher than the $47.76 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 69210's RVU components is multiplied by its Austin, TX GPCI; the products are summed and multiplied by the conversion factor.

Code
69210
DOS
Not selected; uses this release’s rates
Locality
AUSTIN (TX)
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 Austin, TX allowed amount for 69210
Component RVU × GPCI = Adjusted
Work 0.59 × 1.002 0.5912
Practice expense · Office (non-facility) 0.77 × 1.058 0.8147
Malpractice 0.07 × 0.886 0.0620
Sum of adjusted RVUs 1.4679
× 33.4009 conversion factor = formula amount $49.03

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

  1. Locality-adjusted allowed amount $49.03

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • 69210’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 7,595 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    69210
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.59
    G Non-facility PE RVU
    0.77
    K MP RVU
    0.07
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 7,593–7,597 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 04412-31’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 96 in rvu26d-updated-08-26-2026.zip

    A MAC
    04412
    C Locality number
    31
    E Work GPCI
    1.002
    F PE GPCI
    1.058
    G MP GPCI
    0.886
    In the CMS file

    Loading rows 94–98 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

CMS RVU26DOctober 1 – December 31, 2026revision 2

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 69210 in Austin, TX is $27.12, versus $49.03 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 69210 in Austin, TX?

$27.12 in a facility, versus $49.03 in the Office (non-facility) setting—a $21.91 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 Austin, TX. 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 69210 in Austin, TX
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $49.03
Non-participating allowed amount 95% of the participating amount. $46.58
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $53.57
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $39.22
Patient coinsurance The remaining 20%. $9.81
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $0.78
Net Medicare payment Medicare's share after the sequestration reduction. $38.44
What is the non-participating amount and limiting charge for 69210 in Austin, TX?

A non-participating provider is paid $46.58—95% of the $49.03 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $53.57, which is 115% of the non-participating amount.

How much of the Austin, TX 69210 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($39.22) once the annual Part B deductible is met, and the beneficiary owes 20% ($9.81). Sequestration reduces Medicare's share by about 2% ($0.78), leaving $38.44. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Austin, TX 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—$49.03 in the office (non-facility) setting—not the $47.76 national baseline.

Opens the calculator set to Austin, TX 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.

69210 in nearby payment localities Copy link

Payment localities in the same region as Austin, TX, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 69210. Neighboring localities often differ.

Percentages are against Austin, TX. Every payment locality nationwide is on the CPT 69210 rate map.

Other codes priced in Austin, TX Copy link

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

Other curated codes and their allowed amounts in Austin, TX
Code and service Allowed vs. national
31231 Diagnostic Nasal Endoscopy $201.69 +4.3%
69436 Ear, nose and throat $147.74 +2.2%
42820 Ear, nose and throat $264.91 +1.6%
99213 Routine Follow-Up Office Visit $97.77 +2.7%
99214 Long Follow-Up Office Visit $139.08 +2.6%
66984 Cataract Surgery $472.92 +2.2%
92014 Full Eye Exam, Returning Patient $131.75 +3.5%
99204 Long New Patient Office Visit $181.40 +2.3%
99212 Brief Follow-Up Office Visit $61.25 +3.0%
99215 Longest Follow-Up Office Visit $197.10 +2.4%
97110 Physical Therapy Exercises $29.85 +2.7%
99203 New Patient Office Visit $120.48 +2.5%

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 04412-31'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 7,595)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 96)
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 69210 in Austin, TX 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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