Medicare Physician Fee Schedule · Q3 2026 release

CPT 97110 in Boston, MA 14212-01

Physical therapy exercises in ZIPs including 02108, 02116, and 02110

97110 2026 C ·

14212-01 A Active

Non-facility Facility

Allowed amount

$32.29

in a doctor’s own office or clinic

111.1% of the $29.06 national baseline

Medicare payment: $25.83
Patient / secondary: $6.46
Expected total to provider: $32.29

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.

Locality-adjusted Physician Fee Schedule pricing

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

RVU × GPCI components of this amount
Component	RVU	× GPCI	= Adjusted
Work	0.45	× 1.041	0.4685
Practice expense	0.41	× 1.194	0.4895
Malpractice	0.01	× 0.890	0.0089
Sum of adjusted RVUs			0.9669
× 33.4009 conversion factor			$32.29

Citations

Physician relative value file (PPRRVU) PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,798)

hcpcs (col 1)

97110

status_code (col 4)

A

work_rvu (col 6)

0.45

pe_rvu_nonfacility (col 7)

0.41

pe_rvu_facility (col 9)

0.41

mp_rvu (col 11)

0.01
Geographic practice cost indices (GPCI) GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 62)

work_gpci (col 5)

1.041

pe_gpci (col 6)

1.194

mp_gpci (col 7)

0.89
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 97110 in Boston, MA? Copy link

The Medicare allowed amount is $32.29 in the office (non-facility) and facility settings, under the Q3 2026 Physician Fee Schedule. That is 11.1% 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 Boston, MA in? Copy link

CMS payment locality Metropolitan Boston (14212-01). Every location in it is priced identically.

Why Boston, MA differs from the national amount Copy link

Boston, MA (this locality)

$32.29

National PFS baseline (GPCI 1.000)

$29.06

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 Boston, MA at 11.1% above the national baseline.

Work GPCI

1.041

Practice expense GPCI

1.194

Malpractice GPCI

0.890

2026 conversion factor

$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 97110 in Boston, MA: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Boston, MA allowed amount for 97110
Component	RVU	× GPCI	= Adjusted RVU
Work	0.45	1.041	0.4685
Practice expense	0.41	1.194	0.4895
Malpractice	0.01	0.890	0.0089
Sum of adjusted RVUs			0.9669
× $33.4009 2026 conversion factor			$32.29

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Boston, MA. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 97110 in Boston, MA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full.	$32.29
Non-participating allowed amount 95% of the participating amount.	$30.68
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount.	$35.28
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met.	$25.83
Beneficiary coinsurance The remaining 20%.	$6.46
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share.	$0.52
Medicare pays after sequestration Program payment net of the sequestration reduction.	$25.31

Contracted rate: % of Medicare in Boston, MA 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 — $32.29 in the office (non-facility) setting — not the $29.06 national baseline.

Opens the calculator already set to Boston, MA 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 Boston, MA rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 258 ZIP codes to this payment locality. 97110 prices identically in every one of them. 2 of them span more than one locality and need ZIP+4 for an exact match.

01431 01432 01434 01450 01460 01463 01464 01469 01470 01471 01472 01474 01701 01702 01703 01704 01705 01718 01719 01720 01721 01730 01731 01741 01742 01746 01748 01749 01752 01754 01760 01770 01773 01775 01776 01778 01784 01801 01803 01805 01806 01807 01808 01813 01815 01821 01822 01824 01825 01826 01827 01850 01851 01852 01853 01854 01862 01863 01864 01865 01866 01867 01876 01879 01880 01886 01887 01888 01889 01890 02019 02021 02025 02026 02027 02030 02032 02035 02038 02052 02053 02054 02056 02062 02067 02070 02071 02072 02081 02090 02093 02101 02102 02103 02104 02105 02106 02107 02108 02109

158 more ZIP codes map to this locality. The Boston, MA locality page lists the full set.

Checking a different ZIP code?

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

97110 in nearby payment localities Copy link

Payment localities in the same region as Boston, MA, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 97110. Proximity doesn't imply similar pricing — neighbouring localities often differ.

97110 allowed amount in payment localities near Boston, MA
Metro	Allowed amount	vs. Boston, MA
Providence, RI	$29.76	-7.8%
Hartford, CT	$30.48	-5.6%
Portland, ME	$28.81	-10.8%
New York City, NY	$32.43	+0.4%
Long Island, NY	$32.90	+1.9%
Queens, NY	$32.66	+1.1%

Every payment locality nationwide is on the CPT 97110 rate map.

Other codes priced in Boston, MA Copy link

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

Other curated codes and their allowed amounts in Boston, MA
Code	Service	Boston, MA	vs. national
97140	Hands-On Physical Therapy	$30.80	+11.1%
97530	Daily-Activity Therapy	$39.52	+12.7%
97112	Balance and Coordination Therapy	$36.43	+11.3%
97162	Detailed Physical Therapy Evaluation	$108.88	+11.3%
97161	Physical Therapy Evaluation	$108.88	+11.3%
97163	Physical therapy	$108.88	+11.3%
99213	Routine Follow-Up Office Visit	$106.10	+11.5%
99214	Long Follow-Up Office Visit	$150.68	+11.1%
66984	Cataract Surgery	$510.22	+10.3%
92014	Full Eye Exam, Returning Patient	$144.28	+13.4%
99204	Long New Patient Office Visit	$196.04	+10.5%
99212	Brief Follow-Up Office Visit	$66.80	+12.4%

Common questions Copy link

Which ZIP codes does the Boston, MA rate for 97110 cover?

The CMS ZIP-to-locality crosswalk maps 258 ZIP codes to this payment locality, and every one of them prices 97110 identically. Examples include 01431, 01432, 01434, 01450, 01460, 01463. 2 of them span more than one payment locality, so those need ZIP+4 for an exact match.

Why is the 97110 rate in Boston, MA 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 1.041, practice expense 1.194, malpractice 0.890 — scale each RVU component before the conversion factor is applied, which is why Boston, MA allows more than the $29.06 baseline.

What is the non-participating amount and limiting charge for 97110 in Boston, MA?

A non-participating provider is paid $30.68 — 95% of the $32.29 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $35.28, which is 115% of the non-participating amount.

How much of the Boston, MA 97110 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($25.83) once the annual Part B deductible is met, and the beneficiary owes 20% ($6.46). Sequestration reduces Medicare's share by about 2% ($0.52), leaving $25.31. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

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 14212-01'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.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 12,798)

Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 62)

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 97110 in Boston, MA against the release that governed that date. Past releases need a free account; today's rate does not.

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