Medicare Physician Fee Schedule · Q3 2026 release

CPT 97161 in New York City, NY 13202-01

Physical therapy evaluation in ZIPs including 10001, 10036, and 10007

97161 2026 C ·

13202-01 A Active

Non-facility Facility

Allowed amount

$108.82

in a doctor’s own office or clinic

111.2% of the $97.86 national baseline

Medicare payment: $87.06
Patient / secondary: $21.76
Expected total to provider: $108.82

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	1.54	× 1.064	1.6386
Practice expense	1.38	× 1.162	1.6036
Malpractice	0.01	× 1.586	0.0159
Sum of adjusted RVUs			3.2580
× 33.4009 conversion factor			$108.82

Citations

Physician relative value file (PPRRVU) PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,816)

hcpcs (col 1)

97161

status_code (col 4)

A

work_rvu (col 6)

1.54

pe_rvu_nonfacility (col 7)

1.38

pe_rvu_facility (col 9)

1.38

mp_rvu (col 11)

0.01
Geographic practice cost indices (GPCI) GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 78)

work_gpci (col 5)

1.064

pe_gpci (col 6)

1.162

mp_gpci (col 7)

1.586
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 97161 in New York City, NY? Copy link

The Medicare allowed amount is $108.82 in the office (non-facility) and facility settings, under the Q3 2026 Physician Fee Schedule. That is 11.2% 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 New York City, NY in? Copy link

CMS payment locality Manhattan (13202-01). Every location in it is priced identically.

Why New York City, NY differs from the national amount Copy link

New York City, NY (this locality)

$108.82

National PFS baseline (GPCI 1.000)

$97.86

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 New York City, NY at 11.2% above the national baseline.

Work GPCI

1.064

Practice expense GPCI

1.162

Malpractice GPCI

1.586

2026 conversion factor

$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 97161 in New York City, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the New York City, NY allowed amount for 97161
Component	RVU	× GPCI	= Adjusted RVU
Work	1.54	1.064	1.6386
Practice expense	1.38	1.162	1.6036
Malpractice	0.01	1.586	0.0159
Sum of adjusted RVUs			3.2580
× $33.4009 2026 conversion factor			$108.82

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in New York City, NY. 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 97161 in New York City, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full.	$108.82
Non-participating allowed amount 95% of the participating amount.	$103.38
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount.	$118.89
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met.	$87.06
Beneficiary coinsurance The remaining 20%.	$21.76
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share.	$1.74
Medicare pays after sequestration Program payment net of the sequestration reduction.	$85.32

Contracted rate: % of Medicare in New York City, 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 — $108.82 in the office (non-facility) setting — not the $97.86 national baseline.

Opens the calculator already set to New York City, 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 New York City, NY rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality. 97161 prices identically in every one of them.

10001 10002 10003 10004 10005 10006 10007 10008 10009 10010 10011 10012 10013 10014 10015 10016 10017 10018 10019 10020 10021 10022 10023 10024 10025 10026 10027 10028 10029 10030 10031 10032 10033 10034 10035 10036 10037 10038 10039 10040 10041 10043 10044 10045 10046 10047 10048 10055 10060 10065 10069 10072 10075 10079 10080 10081 10082 10087 10090 10094 10095 10096 10098 10099 10101 10102 10103 10104 10105 10106 10107 10108 10109 10110 10111 10112 10113 10114 10115 10116 10117 10118 10119 10120 10121 10122 10123 10124 10125 10126 10128 10129 10130 10131 10132 10133 10138 10149 10150 10151

65 more ZIP codes map to this locality. The New York City, NY 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.

97161 in nearby payment localities Copy link

Payment localities in the same region as New York City, NY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 97161. Proximity doesn't imply similar pricing — neighbouring localities often differ.

97161 allowed amount in payment localities near New York City, NY
Metro	Allowed amount	vs. New York City, NY
Queens, NY	$109.69	+0.8%
Long Island, NY	$110.15	+1.2%
Northern New Jersey, NJ	$108.50	-0.3%
Philadelphia, PA	$100.74	-7.4%
Hartford, CT	$102.51	-5.8%
Boston, MA	$108.88	+0.1%

Every payment locality nationwide is on the CPT 97161 rate map.

Other codes priced in New York City, NY Copy link

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

Other curated codes and their allowed amounts in New York City, NY
Code	Service	New York City, NY	vs. national
97110	Physical Therapy Exercises	$32.43	+11.6%
97140	Hands-On Physical Therapy	$30.95	+11.7%
97530	Daily-Activity Therapy	$39.45	+12.5%
97112	Balance and Coordination Therapy	$36.54	+11.6%
97162	Detailed Physical Therapy Evaluation	$108.82	+11.2%
97163	Physical therapy	$108.82	+11.2%
99213	Routine Follow-Up Office Visit	$107.63	+13.1%
99214	Long Follow-Up Office Visit	$153.27	+13.0%
66984	Cataract Surgery	$521.72	+12.8%
92014	Full Eye Exam, Returning Patient	$143.79	+13.0%
99204	Long New Patient Office Visit	$200.98	+13.3%
99212	Brief Follow-Up Office Visit	$67.64	+13.8%

Common questions Copy link

Which ZIP codes does the New York City, NY rate for 97161 cover?

The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality, and every one of them prices 97161 identically. Examples include 10001, 10002, 10003, 10004, 10005, 10006.

Why is the 97161 rate in New York City, NY 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 1.064, practice expense 1.162, malpractice 1.586 — scale each RVU component before the conversion factor is applied, which is why New York City, NY allows more than the $97.86 baseline.

What is the non-participating amount and limiting charge for 97161 in New York City, NY?

A non-participating provider is paid $103.38 — 95% of the $108.82 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $118.89, which is 115% of the non-participating amount.

How much of the New York City, NY 97161 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($87.06) once the annual Part B deductible is met, and the beneficiary owes 20% ($21.76). Sequestration reduces Medicare's share by about 2% ($1.74), leaving $85.32. 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 13202-01'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 12,816)

Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 78)

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 97161 in New York City, NY against the release that governed that date. Past releases need a free account; today's rate does not.

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