Medicare Physician Fee Schedule · Q3 2026 release
CPT 76856 in Long Island, NY 13202-02
13202-02
A
Active
- Medicare payment
- $98.74
- Patient / secondary
- $24.68
- Expected total to provider
- $123.42
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.
Status A Medicare calculates a national payment amount for this code and pays it separately when the service is covered. Full definition → Locality-adjusted Physician Fee Schedule pricing
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Citations
-
Physician relative value file (PPRRVU)
PPRRVU2026_Jul_nonQPP.csv
in
rvu26c-updated-06-30-2026.zip
(row 8,766)
- hcpcs (col 1)
- 76856
- status_code (col 4)
- A
- work_rvu (col 6)
- 0.67
- pe_rvu_nonfacility (col 7)
- 2.43
- pe_rvu_facility (col 9)
- 2.43
- mp_rvu (col 11)
- 0.05
-
Geographic practice cost indices (GPCI)
GPCI2026.csv
in
rvu26c-updated-06-30-2026.zip
(row 79)
- work_gpci (col 5)
- 1.064
- pe_gpci (col 6)
- 1.189
- mp_gpci (col 7)
- 1.857
-
Physician relative value file (PPRRVU)
PPRRVU2026_Jul_nonQPP.csv
in
rvu26c-updated-06-30-2026.zip
(row 11)
- conversion_factor (col 26)
- 33.4009
How much does Medicare allow for CPT 76856 in Long Island, NY? Copy link
The Medicare allowed amount is $123.42 in the office (non-facility) and facility settings, under the Q3 2026 Physician Fee Schedule. That is 17.3% 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 Long Island, NY in? Copy link
CMS payment locality NYC Suburbs/Long Island (13202-02). Every location in it is priced identically.
Why Long Island, NY differs from the national amount Copy link
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 Long Island, NY at 17.3% above the national baseline.
Formula and inputs Copy link
The office (non-facility) amount for 76856 in Long Island, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.
| Component | RVU | × GPCI | = Adjusted RVU |
|---|---|---|---|
| Work | 0.67 | 1.064 | 0.7129 |
| Practice expense | 2.43 | 1.189 | 2.8893 |
| Malpractice | 0.05 | 1.857 | 0.0929 |
| Sum of adjusted RVUs | 3.6950 | ||
| × $33.4009 2026 conversion factor | $123.42 | ||
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in Long Island, NY. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $123.42 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $117.25 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. | $134.84 |
| Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. | $98.74 |
| Beneficiary coinsurance The remaining 20%. | $24.68 |
| Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. | $1.97 |
| Medicare pays after sequestration Program payment net of the sequestration reduction. | $96.77 |
Contracted rate: % of Medicare in Long Island, NY 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 — $123.42 in the office (non-facility) setting — not the $105.21 national baseline.
Opens the calculator already set to Long Island, NY 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 Long Island, NY rate covers Copy link
The CMS ZIP-to-locality crosswalk maps 440 ZIP codes to this payment locality. 76856 prices identically in every one of them. 5 of them span more than one locality and need ZIP+4 for an exact match.
340 more ZIP codes map to this locality. The Long Island, NY locality page lists the full set.
Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.
76856 in nearby payment localities Copy link
Payment localities in the same region as Long Island, NY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 76856. Proximity doesn't imply similar pricing — neighbouring localities often differ.
| Metro | Allowed amount | vs. Long Island, NY |
|---|---|---|
| Queens, NY | $122.16 | -1.0% |
| New York City, NY | $120.77 | -2.1% |
| Northern New Jersey, NJ | $119.72 | -3.0% |
| Hartford, CT | $112.26 | -9.0% |
| Philadelphia, PA | $109.27 | -11.5% |
| Boston, MA | $121.69 | -1.4% |
Every payment locality nationwide is on the CPT 76856 rate map.
Other codes priced in Long Island, NY Copy link
Office (non-facility) allowed amounts in this same payment locality, Q3 2026.
| Code | Service | Long Island, NY | vs. national |
|---|---|---|---|
| 76700 | Complete Abdominal Ultrasound | $133.86 | +17.2% |
| 76705 | Limited Abdominal Ultrasound | $100.93 | +17.1% |
| 76536 | Neck Soft-Tissue Ultrasound | $127.67 | +17.6% |
| 76641 | Ultrasound | $117.29 | +17.1% |
| 76870 | Ultrasound | $115.68 | +17.4% |
| 76817 | Ultrasound | $108.47 | +16.8% |
| 76815 | Ultrasound | $95.39 | +17.0% |
| 76801 | Ultrasound | $136.29 | +16.6% |
| 76805 | Ultrasound | $159.15 | +17.1% |
| 76816 | Ultrasound | $129.90 | +16.8% |
| 76811 | Ultrasound | $211.17 | +16.0% |
| 99213 | Routine Follow-Up Office Visit | $109.76 | +15.3% |
Common questions Copy link
Which ZIP codes does the Long Island, NY rate for 76856 cover?
Why is the 76856 rate in Long Island, NY different from the national amount?
What is the non-participating amount and limiting charge for 76856 in Long Island, NY?
How much of the Long Island, NY 76856 rate does Medicare actually pay?
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 13202-02'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.
Working a claim with an earlier date of service? The calculator prices 76856 in Long Island, NY 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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