localis
Rate calculator

Describe a service in plain words, or type a CPT/HCPCS code.

Medicare Physician Fee Schedule · Q4 2026 release

CPT 76817 in Milwaukee, WI

76817 Q4 2026 · Milwaukee, WI flag06302-00
Office (non-facility) Facility
Locality-adjusted allowed amount
$88.89
in a doctor’s own office or clinic

95.7% of the $92.85 national baseline

( Work0.73 × 1.000 + Practice exp.2.00 × 0.958 + Malpractice0.05 × 0.308 ) × Conv. factor$33.4009 = $88.89

row 8,793

F Work RVU

0.73

G Non‑facility PE RVU

2.00

K MP RVU

0.05

Z Conversion factor

33.4009

row 111

E Work GPCI

1.000

F PE GPCI

0.958

G MP GPCI

0.308

CMS RVU26DOctober 1 – December 31, 2026revision 2

The Medicare allowed amount is $88.89 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 06302-00 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Milwaukee, WI in? Copy link

CMS prices all of Wisconsin as one Medicare payment locality, so this amount applies statewide, including Madison, Green Bay and Kenosha—not only in Milwaukee, WI.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (919)

The CMS ZIP-to-locality crosswalk maps 919 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 1 span more than one locality and need ZIP+4 for an exact match.

53001 53002 53003 53004 53005 53006 53007 53008 53009 53010 53011 53012 53013 53014 53015 53016 53017 53018 53019 53020 53021 53022 53023 53024 53026 53027 53029 53031 53032 53033 53034 53035 53036 53037 53038 53039 53040 53042 53044 53045 53046 53047 53048 53049 53050 53051 53052 53056 53057 53058 53059 53060 53061 53062 53063 53064 53065 53066 53069 53070 53072 53073 53074 53075 53076 53078 53079 53080 53081 53082 53083 53085 53086 53088 53089 53090 53091 53092 53093 53094 53095 53097 53098 53099 53101 53102 53103 53104 53105 53108 53109 53110 53114 53115 53118 53119 53120 53121 53122 53125

819 more ZIP codes map to this locality. The Milwaukee, WI locality page lists the full set.

Which ZIP codes does the Milwaukee, WI rate for 76817 cover?

The CMS ZIP-to-locality crosswalk maps 919 ZIP codes to this payment locality, and 76817 has the same amount in every one of them. Examples include 53001, 53002, 53003, 53004, 53005, 53006. Of these, 1 span more than one payment locality and need ZIP+4 for an exact match.

Does this 76817 rate apply everywhere in Wisconsin?

Yes. CMS prices Wisconsin as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Milwaukee, WI. That includes Madison, Green Bay and Kenosha. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Milwaukee, WI (this locality)
$88.89
National PFS baseline (GPCI 1.000)
$92.85

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Milwaukee, WI 4.3% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.958
Malpractice GPCI
0.308
2026 conversion factor
$33.4009

CMS RVU26DOctober 1 – December 31, 2026revision 2 See citations

Why is the 76817 rate in Milwaukee, WI 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 0.958, malpractice 0.308—scale each RVU component before the conversion factor is applied, which is why the Milwaukee, WI amount is lower than the $92.85 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 76817's RVU components is multiplied by its Milwaukee, WI GPCI; the products are summed and multiplied by the conversion factor.

Code
76817
DOS
Not selected; uses this release’s rates
Locality
WISCONSIN (WI)
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 Milwaukee, WI allowed amount for 76817
Component RVU × GPCI = Adjusted
Work 0.73 × 1.000 0.7300
Practice expense · Office (non-facility) 2.00 × 0.958 1.9160
Malpractice 0.05 × 0.308 0.0154
Sum of adjusted RVUs 2.6614
× 33.4009 conversion factor = formula amount $88.89

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

  1. Locality-adjusted allowed amount $88.89

    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.

  • 76817’s RVUs, PFS status and conversion factor

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

    PPRRVU2026_Oct_nonQPP.csv row 8,793 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    76817
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.73
    G Non-facility PE RVU
    2.00
    K MP RVU
    0.05
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 8,791–8,795 of PPRRVU2026_Oct_nonQPP.csv…

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

  • Locality 06302-00’s GPCIs

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

    GPCI2026.csv row 111 in rvu26d-updated-08-26-2026.zip

    A MAC
    06302
    C Locality number
    00
    E Work GPCI
    1.000
    F PE GPCI
    0.958
    G MP GPCI
    0.308
    In the CMS file

    Loading rows 109–113 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 Milwaukee, WI. 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 76817 in Milwaukee, WI
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $88.89
Non-participating allowed amount 95% of the participating amount. $84.45
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $97.12
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $71.11
Patient coinsurance The remaining 20%. $17.78
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $1.42
Net Medicare payment Medicare's share after the sequestration reduction. $69.69
What is the non-participating amount and limiting charge for 76817 in Milwaukee, WI?

A non-participating provider is paid $84.45—95% of the $88.89 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $97.12, which is 115% of the non-participating amount.

How much of the Milwaukee, WI 76817 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($71.11) once the annual Part B deductible is met, and the beneficiary owes 20% ($17.78). Sequestration reduces Medicare's share by about 2% ($1.42), leaving $69.69. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Milwaukee, WI 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—$88.89 in the office (non-facility) setting—not the $92.85 national baseline.

Opens the calculator set to Milwaukee, WI 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 76817 in nearby payment localities

Payment localities in the same region as Milwaukee, WI, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 76817. Neighboring localities often differ.

76817 allowed amount in payment localities near Milwaukee, WI
Metro Allowed amount vs. Milwaukee, WI
Chicago, IL $95.52 +7.5%
Suburban Chicago, IL $96.12 +8.1%
Minneapolis, MN $93.62 +5.3%
Des Moines, IA $86.17 -3.1%
Detroit, MI $91.66 +3.1%
Indianapolis, IN $87.12 -2.0%

Every payment locality nationwide is on the CPT 76817 rate map.

Other codes priced in Milwaukee, WI Copy link

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

Other curated codes and their allowed amounts in Milwaukee, WI
Code and service Allowed vs. national
76700 Complete Abdominal Ultrasound $109.24 -4.4%
76705 Limited Abdominal Ultrasound $82.50 -4.3%
76536 Neck Soft-Tissue Ultrasound $103.90 -4.3%
76856 Ultrasound $100.65 -4.3%
76641 Ultrasound $95.90 -4.3%
76870 Ultrasound $94.18 -4.4%
76815 Ultrasound $77.87 -4.5%
76801 Ultrasound $112.05 -4.1%
76805 Ultrasound $130.07 -4.3%
76816 Ultrasound $106.63 -4.1%
76811 Ultrasound $174.60 -4.1%
99213 Routine Follow-Up Office Visit $91.06 -4.3%

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 06302-00'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 8,793)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 111)
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 76817 in Milwaukee, WI against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

Did this answer your question about CPT 76817 in Milwaukee, WI?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.

Did this page answer your question?