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Medicare Physician Fee Schedule · Q4 2026 release

CPT 92012 in Kansas City, MO

Established patient eye examination, intermediate in ZIPs including 64105, 64108, and 64111

92012 Q4 2026 · Kansas City, MO flag05302-02
Locality-adjusted allowed amount
$86.91
in a doctor’s own office or clinic

96% of the $90.52 national baseline

( Work0.92 × 1.000 + Practice exp.1.76 × 0.939 + Malpractice0.03 × 0.977 ) × Conv. factor$33.4009 = $86.91

The Medicare allowed amount is $86.91 in the Office (non-facility) setting and $40.80 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.

Q4 2026 · Locality 05302-02 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Kansas City, MO in? Copy link

Kansas City, MO is in CMS payment locality Metropolitan Kansas City (05302-02). 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 (126)

The CMS ZIP-to-locality crosswalk maps 126 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 9 span more than one locality and need ZIP+4 for an exact match.

64002 64013 64014 64015 64016 64018 64024 64028 64029 64030 64034 64048 64050 64051 64052 64053 64054 64055 64056 64057 64058 64060 64063 64064 64065 64066 64068 64069 64070 64072 64073 64075 64079 64081 64082 64086 64087 64088 64089 64092 64098 64101 64102 64105 64106 64108 64109 64110 64111 64112 64113 64114 64116 64117 64118 64119 64120 64121 64123 64124 64125 64126 64127 64128 64129 64130 64131 64132 64133 64134 64136 64137 64138 64139 64141 64142 64144 64145 64146 64147 64148 64149 64150 64151 64152 64153 64154 64155 64156 64157 64158 64160 64161 64162 64163 64164 64165 64166 64167 64168

26 more ZIP codes map to this locality. The Kansas City, MO locality page lists the full set.

Which ZIP codes does the Kansas City, MO rate for 92012 cover?

The CMS ZIP-to-locality crosswalk maps 126 ZIP codes to this payment locality, and 92012 has the same amount in every one of them. Examples include 64002, 64013, 64014, 64015, 64016, 64018. Of these, 9 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

Kansas City, MO (this locality)
$86.91
National PFS baseline (GPCI 1.000)
$90.52

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Kansas City, MO 4.0% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.939
Malpractice GPCI
0.977
2026 conversion factor
$33.4009
Why is the 92012 rate in Kansas City, 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 0.939, malpractice 0.977—scale each RVU component before the conversion factor is applied, which is why the Kansas City, MO amount is lower than the $90.52 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 92012's RVU components is multiplied by its Kansas City, MO GPCI; the products are summed and multiplied by the conversion factor.

Code
92012
DOS
Not selected; uses this release’s rates
Locality
METROPOLITAN KANSAS CITY (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.

RVU × GPCI components of Kansas City, MO allowed amount for 92012
Component RVU × GPCI = Adjusted
Work 0.92 × 1.000 0.9200
Practice expense · Office (non-facility) 1.76 × 0.939 1.6526
Malpractice 0.03 × 0.977 0.0293
Sum of adjusted RVUs 2.6020
× 33.4009 conversion factor = formula amount $86.91

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

  1. Locality-adjusted allowed amount $86.91

    After applicable fee-schedule adjustments; sequestration excluded

Citations

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

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11,661)
    hcpcs (col 1)
    92012
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    0.92
    pe_rvu_nonfacility (col 7)
    1.76
    pe_rvu_facility (col 9)
    0.29
    mp_rvu (col 11)
    0.03

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details GPCI2026.csv in rvu26d-updated-08-26-2026.zip (row 68)
    mac (col 1)
    05302
    locality_code (col 3)
    02
    work_gpci (col 5)
    1
    pe_gpci (col 6)
    0.939
    mp_gpci (col 7)
    0.977

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 92012 in Kansas City, MO is $40.80, versus $86.91 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 92012 in Kansas City, MO?

$40.80 in a facility, versus $86.91 in the Office (non-facility) setting—a $46.11 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 Kansas City, 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.

Participation and payment-split amounts for 92012 in Kansas City, MO
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $86.91
Non-participating allowed amount 95% of the participating amount. $82.56
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $94.94
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $69.53
Patient coinsurance The remaining 20%. $17.38
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $1.39
Net Medicare payment Medicare's share after the sequestration reduction. $68.14
What is the non-participating amount and limiting charge for 92012 in Kansas City, MO?

A non-participating provider is paid $82.56—95% of the $86.91 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $94.94, which is 115% of the non-participating amount.

How much of the Kansas City, MO 92012 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($69.53) once the annual Part B deductible is met, and the beneficiary owes 20% ($17.38). Sequestration reduces Medicare's share by about 2% ($1.39), leaving $68.14. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Kansas City, 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—$86.91 in the office (non-facility) setting—not the $90.52 national baseline.

Opens the calculator set to Kansas City, 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 92012 in nearby payment localities

Payment localities in the same region as Kansas City, MO, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 92012. Neighboring localities often differ.

92012 allowed amount in payment localities near Kansas City, MO
Metro Allowed amount vs. Kansas City, MO
Wichita, KS $84.38 -2.9%
Omaha, NE $85.37 -1.8%
St. Louis, MO $87.70 +0.9%
Des Moines, IA $84.92 -2.3%
Oklahoma City, OK $84.00 -3.3%
Chicago, IL $92.32 +6.2%

Every payment locality nationwide is on the CPT 92012 rate map.

Other codes priced in Kansas City, MO Copy link

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

Other curated codes and their allowed amounts in Kansas City, MO
Code and service Allowed vs. national
92014 Full Eye Exam, Returning Patient $122.44 -3.8%
92004 New Patient Eye Examination, Comprehensive $144.27 -3.6%
67028 Intravitreal Medication Injection $110.26 -3.5%
92134 Retina Scan $31.39 -4.1%
99213 Routine Follow-Up Office Visit $92.15 -3.2%
99214 Long Follow-Up Office Visit $131.43 -3.1%
66984 Cataract Surgery $449.68 -2.8%
99204 Long New Patient Office Visit $172.14 -2.9%
99212 Brief Follow-Up Office Visit $57.33 -3.6%
99215 Longest Follow-Up Office Visit $186.62 -3.0%
97110 Physical Therapy Exercises $28.22 -2.9%
99203 New Patient Office Visit $113.86 -3.2%

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 05302-02'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 11,661)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 68)
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 92012 in Kansas City, 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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