Medicare Physician Fee Schedule · Q4 2026 release
CPT 72125 in St. Louis, MO
Cervical spine ct without contrast in ZIPs including 63101, 63108, and 63105
05302-01
Status A
Medicare calculates a national payment amount for this code and pays it separately when the service is covered.
Full definition →
3.5% below the national baseline ($130.60)
( Work0.98 × 1.000 + Practice exp.2.86 × 0.952 + Malpractice0.07 × 1.002 ) × Conv. factor$33.4009 = $126.02
F Work RVU
0.98
G Non‑facility PE RVU
2.86
K MP RVU
0.07
Z Conversion factor
33.4009
E Work GPCI
1.000
F PE GPCI
0.952
G MP GPCI
1.002
CMS RVU26DOctober 1 – December 31, 2026revision 2
- Code
- 72125
- DOS
- Not selected; uses this release’s rates
- Locality
- METROPOLITAN ST. LOUIS (MO)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q4 2026, revision 2
- Sequestration
- Shown separately from the allowed amount
Citations
Every input comes from a published CMS file. Open the same file at the row shown and the values match.
-
72125’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 7,985 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 72125
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 0.98
- G Non-facility PE RVU
- 2.86
- K MP RVU
- 0.07
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 7,983–7,987 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 05302-01’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 69 in rvu26d-updated-08-26-2026.zip
- A MAC
- 05302
- C Locality number
- 01
- E Work GPCI
- 1.000
- F PE GPCI
- 0.952
- G MP GPCI
- 1.002
In the CMS file
Loading rows 67–71 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
The Medicare allowed amount is $126.02 in the Office (non-facility) and Facility settings, 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 05302-01 · Participating · Whole service · Sequestration excluded
What Medicare locality is St. Louis, MO in? Copy link
St. Louis, MO is in CMS payment locality Metropolitan St. Louis (05302-01). 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 (131)
The CMS ZIP-to-locality crosswalk maps 131 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 7 span more than one locality and need ZIP+4 for an exact match.
31 more ZIP codes map to this locality. The St. Louis, MO locality page lists the full set.
Which ZIP codes does the St. Louis, MO rate for 72125 cover?
The CMS ZIP-to-locality crosswalk maps 131 ZIP codes to this payment locality, and 72125 has the same amount in every one of them. Examples include 63001, 63005, 63006, 63010, 63011, 63012. Of these, 7 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
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put St. Louis, MO 3.5% below the national baseline.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See citations
Why is the 72125 rate in St. Louis, MO 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 1.000, practice expense 0.952, malpractice 1.002—scale each RVU component before the conversion factor is applied, which is why the St. Louis, MO amount is lower than the $130.60 baseline.
Formula and inputs Copy link
For the office (non-facility) amount, each of 72125's RVU components is multiplied by its St. Louis, MO GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 72125
- DOS
- Not selected; uses this release’s rates
- Locality
- METROPOLITAN ST. LOUIS (MO)
- 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.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 0.98 | × 1.000 | 0.9800 |
| Practice expense · Office (non-facility) | 2.86 | × 0.952 | 2.7227 |
| Malpractice | 0.07 | × 1.002 | 0.0701 |
| Sum of adjusted RVUs | 3.7729 | ||
| × 33.4009 conversion factor = formula amount | $126.02 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
-
Locality-adjusted allowed amount $126.02
After applicable fee-schedule adjustments; sequestration excluded
Citations
Every input comes from a published CMS file. Open the same file at the row shown and the values match.
-
72125’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 7,985 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 72125
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 0.98
- G Non-facility PE RVU
- 2.86
- K MP RVU
- 0.07
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 7,983–7,987 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 05302-01’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 69 in rvu26d-updated-08-26-2026.zip
- A MAC
- 05302
- C Locality number
- 01
- E Work GPCI
- 1.000
- F PE GPCI
- 0.952
- G MP GPCI
- 1.002
In the CMS file
Loading rows 67–71 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
CMS RVU26DOctober 1 – December 31, 2026revision 2
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in St. Louis, MO. 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.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $126.02 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $119.72 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $137.68 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $100.82 |
| Patient coinsurance The remaining 20%. | $25.20 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $2.02 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $98.80 |
What is the non-participating amount and limiting charge for 72125 in St. Louis, MO?
A non-participating provider is paid $119.72—95% of the $126.02 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $137.68, which is 115% of the non-participating amount.
How much of the St. Louis, MO 72125 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($100.82) once the annual Part B deductible is met, and the beneficiary owes 20% ($25.20). Sequestration reduces Medicare's share by about 2% ($2.02), leaving $98.80. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in St. Louis, MO 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—$126.02 in the office (non-facility) setting—not the $130.60 national baseline.
Opens the calculator set to St. Louis, MO 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 72125 in nearby payment localities
Payment localities in the same region as St. Louis, MO, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 72125. Neighboring localities often differ.
| Metro | Allowed amount | vs. St. Louis, MO |
|---|---|---|
| Metro East, IL | $125.33 | -0.5% |
| Kansas City, MO | $124.72 | -1.0% |
| Indianapolis, IN | $122.42 | -2.9% |
| Chicago, IL | $134.33 | +6.6% |
| Louisville, KY | $119.80 | -4.9% |
| Nashville, TN | $120.82 | -4.1% |
Every payment locality nationwide is on the CPT 72125 rate map.
Other codes priced in St. Louis, MO Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 70450 Head CT Without Contrast | $102.87 | -3.5% |
| 74177 Abdomen and Pelvis CT With Contrast | $288.92 | -3.8% |
| 74176 Abdomen and Pelvis CT Without Contrast | $177.16 | -3.2% |
| 71260 Chest CT With Contrast | $160.63 | -3.6% |
| 71250 Chest CT Without Contrast | $128.04 | -3.4% |
| 74178 Abdomen and Pelvis CT With and Without Contrast | $325.19 | -3.8% |
| 70486 CT imaging | $123.53 | -3.7% |
| 71271 CT imaging | $131.55 | -3.5% |
| 72131 Lumbar Spine CT Without Contrast | $125.38 | -3.5% |
| 70470 CT imaging | $166.85 | -3.6% |
| 72128 CT imaging | $125.70 | -3.5% |
| 71270 CT imaging | $188.44 | -3.7% |
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 05302-01'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.
Working a claim with an earlier date of service? The calculator prices 72125 in St. Louis, MO 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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