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Medicare Physician Fee Schedule · Q3 2026 release

CPT 90792 in Columbus, OH

Psychiatric diagnostic evaluation with medical services in ZIPs including 43215, 44113, and 45202

90792 Q3 2026 · Columbus, OH flag15202-00 A Active
Locality-adjusted allowed amount
$197.12
in a doctor’s own office or clinic

97.5% of the $202.08 national baseline

The Medicare allowed amount is $197.12 in the Office (non-facility) setting and $158.09 in a facility, under the Q3 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.

Q3 2026 · Locality 15202-00 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Columbus, OH in? Copy link

CMS prices all of Ohio as one Medicare payment locality, so this amount applies statewide, including Cleveland, Cincinnati, Toledo and Akron—not only in Columbus, OH.

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

ZIP codes in this payment locality (1,489)

The CMS ZIP-to-locality crosswalk maps 1,489 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.

43001 43002 43003 43004 43005 43006 43007 43008 43009 43010 43011 43013 43014 43015 43016 43017 43018 43019 43021 43022 43023 43025 43026 43027 43028 43029 43030 43031 43032 43033 43035 43036 43037 43040 43041 43044 43045 43046 43047 43048 43050 43054 43055 43056 43058 43060 43061 43062 43064 43065 43066 43067 43068 43069 43070 43071 43072 43073 43074 43076 43077 43078 43080 43081 43082 43083 43084 43085 43086 43093 43098 43099 43101 43102 43103 43105 43106 43107 43109 43110 43111 43112 43113 43115 43116 43117 43119 43123 43125 43126 43127 43128 43130 43135 43136 43137 43138 43140 43142 43143

1,389 more ZIP codes map to this locality. The Columbus, OH locality page lists the full set.

Which ZIP codes does the Columbus, OH rate for 90792 cover?

The CMS ZIP-to-locality crosswalk maps 1,489 ZIP codes to this payment locality, and 90792 has the same amount in every one of them. Examples include 43001, 43002, 43003, 43004, 43005, 43006.

Does this 90792 rate apply everywhere in Ohio?

Yes. CMS prices Ohio as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Columbus, OH. That includes Cleveland, Cincinnati, Toledo and Akron. 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) · Q3 2026 · Participating · Whole service

Columbus, OH (this locality)
$197.12
National PFS baseline (GPCI 1.000)
$202.08

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Columbus, OH 2.5% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.913
Malpractice GPCI
1.008
2026 conversion factor
$33.4009
Why is the 90792 rate in Columbus, OH 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 0.913, malpractice 1.008—scale each RVU component before the conversion factor is applied, which is why the Columbus, OH amount is lower than the $202.08 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 90792's RVU components is multiplied by its Columbus, OH GPCI; the products are summed and multiplied by the conversion factor.

Code
90792
DOS
Not selected; uses this release’s rates
Locality
Ohio (OH)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q3 2026, revision 1
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 Columbus, OH allowed amount for 90792
Component RVU × GPCI = Adjusted
Work 4.16 × 1.000 4.1600
Practice expense · Office (non-facility) 1.72 × 0.913 1.5704
Malpractice 0.17 × 1.008 0.1714
Sum of adjusted RVUs 5.9017
× 33.4009 conversion factor = formula amount $197.12
  1. Locality-adjusted allowed amount $197.12

    After applicable fee-schedule adjustments; sequestration excluded

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

Citations

  • Supplies the RVUs and PFS status for this code and component.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11,467)
    hcpcs (col 1)
    90792
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    4.16
    pe_rvu_nonfacility (col 7)
    1.72
    pe_rvu_facility (col 9)
    0.44
    mp_rvu (col 11)
    0.17

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 85)
    mac (col 1)
    15202
    locality_code (col 3)
    00
    work_gpci (col 5)
    1
    pe_gpci (col 6)
    0.913
    mp_gpci (col 7)
    1.008

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 90792 in Columbus, OH is $158.09, versus $197.12 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 90792 in Columbus, OH?

$158.09 in a facility, versus $197.12 in the Office (non-facility) setting—a $39.03 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 Columbus, OH. 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 90792 in Columbus, OH
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $197.12
Non-participating allowed amount 95% of the participating amount. $187.26
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $215.35
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $157.70
Patient coinsurance The remaining 20%. $39.42
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $3.15
Net Medicare payment Medicare's share after the sequestration reduction. $154.55
What is the non-participating amount and limiting charge for 90792 in Columbus, OH?

A non-participating provider is paid $187.26—95% of the $197.12 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $215.35, which is 115% of the non-participating amount.

How much of the Columbus, OH 90792 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($157.70) once the annual Part B deductible is met, and the beneficiary owes 20% ($39.42). Sequestration reduces Medicare's share by about 2% ($3.15), leaving $154.55. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Columbus, OH 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—$197.12 in the office (non-facility) setting—not the $202.08 national baseline.

Opens the calculator set to Columbus, OH 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 90792 in nearby payment localities

Payment localities in the same region as Columbus, OH, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 90792. Neighboring localities often differ.

90792 allowed amount in payment localities near Columbus, OH
Metro Allowed amount vs. Columbus, OH
Indianapolis, IN $194.96 -1.1%
Louisville, KY $195.22 -1.0%
Pittsburgh, PA $197.05 —
Buffalo, NY $197.52 +0.2%

Every payment locality nationwide is on the CPT 90792 rate map.

Other codes priced in Columbus, OH Copy link

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

Other curated codes and their allowed amounts in Columbus, OH
Code and service Allowed vs. national
90834 Standard Therapy Session $111.49 -2.1%
90837 Extended Therapy Session $163.52 -2.1%
90791 Psychiatric Diagnostic Evaluation $169.49 -2.2%
90853 Behavioral health $29.73 -2.2%
99213 Routine Follow-Up Office Visit $90.97 -4.4%
99214 Long Follow-Up Office Visit $129.83 -4.3%
66984 Cataract Surgery $444.90 -3.8%
92014 Full Eye Exam, Returning Patient $120.44 -5.4%
99204 Long New Patient Office Visit $170.25 -4.0%
99212 Brief Follow-Up Office Visit $56.51 -4.9%
99215 Longest Follow-Up Office Visit $184.45 -4.1%
97110 Physical Therapy Exercises $27.87 -4.1%

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 15202-00's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 11,467)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 85)
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 90792 in Columbus, OH against the release in effect on that date. Dates in the last 12 months don't need an account; older dates of service need a free account.

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