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Medicare Physician Fee Schedule · Q3 2026 release

CPT 98942 in Long Island, NY 13202-02

98942 2026 C · Long Island, NY flag13202-02 A Active
Allowed amount
$55.47
in a doctor’s own office or clinic

111.5% of the $49.77 national baseline

Medicare payment
$44.38
Patient / secondary
$11.09
Expected total to provider
$55.47

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

How much does Medicare allow for CPT 98942 in Long Island, NY? Copy link

The Medicare allowed amount is $55.47 in the office (non-facility) setting and $41.57 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 11.5% above the national baseline, and the facility amount is 9.2% 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 Long Island, NY in? Copy link

CMS payment locality NYC Suburbs/Long Island (13202-02). Every location in it is priced identically.

Why Long Island, NY differs from the national amount Copy link

Long Island, NY (this locality)
$55.47
National PFS baseline (GPCI 1.000)
$49.77

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 Long Island, NY at 11.5% above the national baseline.

Work GPCI
1.064
Practice expense GPCI
1.189
Malpractice GPCI
1.857
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 98942 in Long Island, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Long Island, NY allowed amount for 98942
Component RVU × GPCI = Adjusted RVU
Work 0.94 1.064 1.0002
Practice expense 0.54 1.189 0.6421
Malpractice 0.01 1.857 0.0186
Sum of adjusted RVUs 1.6608
× $33.4009 2026 conversion factor $55.47

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Long Island, NY allows $41.57 for 98942, versus $55.47 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Long Island, 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 98942 in Long Island, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $55.47
Non-participating allowed amount 95% of the participating amount. $52.70
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $60.61
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $44.38
Beneficiary coinsurance The remaining 20%. $11.09
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $0.89
Medicare pays after sequestration Program payment net of the sequestration reduction. $43.49

Contracted rate: % of Medicare in Long Island, 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 — $55.47 in the office (non-facility) setting — not the $49.77 national baseline.

Opens the calculator already set to Long Island, 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 Long Island, NY rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 440 ZIP codes to this payment locality. 98942 prices identically in every one of them. 5 of them span more than one locality and need ZIP+4 for an exact match.

00501 00544 06390 10301 10302 10303 10304 10305 10306 10307 10308 10309 10310 10311 10312 10313 10314 10451 10452 10453 10454 10455 10456 10457 10458 10459 10460 10461 10462 10463 10464 10465 10466 10467 10468 10469 10470 10471 10472 10473 10474 10475 10499 10501 10502 10503 10504 10505 10506 10507 10510 10511 10514 10517 10518 10519 10520 10521 10522 10523 10526 10527 10528 10530 10532 10533 10535 10536 10538 10540 10543 10545 10546 10547 10548 10549 10550 10551 10552 10553 10557 10558 10559 10560 10562 10566 10567 10570 10571 10572 10573 10576 10577 10578 10580 10581 10583 10587 10588 10589

340 more ZIP codes map to this locality. The Long Island, NY locality page lists the full set.

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

98942 in nearby payment localities Copy link

Payment localities in the same region as Long Island, NY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 98942. Proximity doesn't imply similar pricing — neighbouring localities often differ.

98942 allowed amount in payment localities near Long Island, NY
Metro Allowed amount vs. Long Island, NY
Queens, NY $55.21 -0.5%
New York City, NY $54.89 -1.0%
Northern New Jersey, NJ $54.65 -1.5%
Hartford, CT $51.85 -6.5%
Philadelphia, PA $51.14 -7.8%
Boston, MA $54.52 -1.7%

Every payment locality nationwide is on the CPT 98942 rate map.

Other codes priced in Long Island, NY Copy link

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

Other curated codes and their allowed amounts in Long Island, NY
Code Service Long Island, NY vs. national
98941 Chiropractic Spinal Manipulation, Multiple Regions $43.01 +12.0%
98940 Chiropractic Spinal Manipulation $30.12 +12.7%
99213 Routine Follow-Up Office Visit $109.76 +15.3%
99214 Long Follow-Up Office Visit $156.34 +15.3%
66984 Cataract Surgery $532.15 +15.0%
92014 Full Eye Exam, Returning Patient $146.27 +14.9%
99204 Long New Patient Office Visit $205.38 +15.8%
99212 Brief Follow-Up Office Visit $69.11 +16.2%
99215 Longest Follow-Up Office Visit $221.75 +15.3%
97110 Physical Therapy Exercises $32.90 +13.2%
99203 New Patient Office Visit $136.68 +16.3%
93010 Heart Tracing Reading $9.44 +13.1%

Common questions Copy link

Which ZIP codes does the Long Island, NY rate for 98942 cover?
The CMS ZIP-to-locality crosswalk maps 440 ZIP codes to this payment locality, and every one of them prices 98942 identically. Examples include 00501, 00544, 06390, 10301, 10302, 10303. 5 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 98942 rate in Long Island, 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 1.189, malpractice 1.857 — scale each RVU component before the conversion factor is applied, which is why Long Island, NY allows more than the $49.77 baseline.
What is the facility rate for 98942 in Long Island, NY?
$41.57 in a facility, versus $55.47 in the office (non-facility) setting — a $13.90 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 98942 in Long Island, NY?
A non-participating provider is paid $52.70 — 95% of the $55.47 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $60.61, which is 115% of the non-participating amount.
How much of the Long Island, NY 98942 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($44.38) once the annual Part B deductible is met, and the beneficiary owes 20% ($11.09). Sequestration reduces Medicare's share by about 2% ($0.89), leaving $43.49. 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 13202-02'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 12,883)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 79)
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 98942 in Long Island, NY against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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