Medicare Physician Fee Schedule · Q3 2026 release
CPT 95810 in Queens, NY 13292-04
13292-04
A
Active
- Medicare payment
- $631.16
- Patient / secondary
- $157.79
- Expected total to provider
- $788.95
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 12,483)
- hcpcs (col 1)
- 95810
- status_code (col 4)
- A
- work_rvu (col 6)
- 2.44
- pe_rvu_nonfacility (col 7)
- 17.47
- pe_rvu_facility (col 9)
- 17.47
- mp_rvu (col 11)
- 0.26
-
Geographic practice cost indices (GPCI)
GPCI2026.csv
in
rvu26c-updated-06-30-2026.zip
(row 81)
- work_gpci (col 5)
- 1.064
- pe_gpci (col 6)
- 1.182
- mp_gpci (col 7)
- 1.442
-
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 95810 in Queens, NY? Copy link
The Medicare allowed amount is $788.95 in the office (non-facility) and facility settings, under the Q3 2026 Physician Fee Schedule. That is 17.1% 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 Queens, NY in? Copy link
CMS payment locality Queens (13292-04). Every location in it is priced identically.
Why Queens, 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 Queens, NY at 17.1% above the national baseline.
Formula and inputs Copy link
The office (non-facility) amount for 95810 in Queens, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.
| Component | RVU | × GPCI | = Adjusted RVU |
|---|---|---|---|
| Work | 2.44 | 1.064 | 2.5962 |
| Practice expense | 17.47 | 1.182 | 20.6495 |
| Malpractice | 0.26 | 1.442 | 0.3749 |
| Sum of adjusted RVUs | 23.6206 | ||
| × $33.4009 2026 conversion factor | $788.95 | ||
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in Queens, 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. | $788.95 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $749.50 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. | $861.93 |
| Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. | $631.16 |
| Beneficiary coinsurance The remaining 20%. | $157.79 |
| Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. | $12.62 |
| Medicare pays after sequestration Program payment net of the sequestration reduction. | $618.54 |
Contracted rate: % of Medicare in Queens, 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 — $788.95 in the office (non-facility) setting — not the $673.70 national baseline.
Opens the calculator already set to Queens, 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 Queens, NY rate covers Copy link
The CMS ZIP-to-locality crosswalk maps 84 ZIP codes to this payment locality. 95810 prices identically in every one of them. 1 of them span more than one locality and need ZIP+4 for an exact match.
Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.
95810 in nearby payment localities Copy link
Payment localities in the same region as Queens, NY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 95810. Proximity doesn't imply similar pricing — neighbouring localities often differ.
| Metro | Allowed amount | vs. Queens, NY |
|---|---|---|
| New York City, NY | $778.53 | -1.3% |
| Long Island, NY | $796.64 | +1.0% |
| Northern New Jersey, NJ | $772.78 | -2.0% |
| Philadelphia, PA | $700.76 | -11.2% |
| Hartford, CT | $722.08 | -8.5% |
| Boston, MA | $789.28 | — |
Every payment locality nationwide is on the CPT 95810 rate map.
Other codes priced in Queens, NY Copy link
Office (non-facility) allowed amounts in this same payment locality, Q3 2026.
| Code | Service | Queens, NY | vs. national |
|---|---|---|---|
| 95811 | Sleep studies and neurodiagnostics | $829.00 | +17.1% |
| 95886 | Needle Electromyography Study | $114.99 | +15.1% |
| 95910 | Sleep studies and neurodiagnostics | $211.33 | +14.4% |
| 99213 | Routine Follow-Up Office Visit | $108.18 | +13.6% |
| 99214 | Long Follow-Up Office Visit | $153.94 | +13.5% |
| 66984 | Cataract Surgery | $523.23 | +13.1% |
| 92014 | Full Eye Exam, Returning Patient | $145.17 | +14.1% |
| 99204 | Long New Patient Office Visit | $201.47 | +13.6% |
| 99212 | Brief Follow-Up Office Visit | $68.04 | +14.4% |
| 99215 | Longest Follow-Up Office Visit | $218.19 | +13.4% |
| 97110 | Physical Therapy Exercises | $32.66 | +12.4% |
| 99203 | New Patient Office Visit | $134.05 | +14.0% |
Common questions Copy link
Which ZIP codes does the Queens, NY rate for 95810 cover?
Why is the 95810 rate in Queens, NY different from the national amount?
What is the non-participating amount and limiting charge for 95810 in Queens, NY?
How much of the Queens, NY 95810 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 13292-04'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 95810 in Queens, NY against the release that governed that date. Past releases need a free account; today's rate does not.
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