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Medicare Physician Fee Schedule · Q3 2026 release

CPT 99203 in Queens, NY

New patient office visit in ZIPs including 11101, 11354, and 11375

99203 Q3 2026 · Queens, NY flag13292-04
Locality-adjusted allowed amount
$134.05
in a doctor’s own office or clinic

114% of the $117.57 national baseline

( Work1.60 × 1.064 + Practice exp.1.76 × 1.182 + Malpractice0.16 × 1.442 ) × Conv. factor$33.4009 = $134.05

The Medicare allowed amount is $134.05 in the Office (non-facility) setting and $79.57 in a facility, under the Q3 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.

Q3 2026 · Locality 13292-04 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Queens, NY in? Copy link

Queens, NY is in CMS payment locality Queens (13292-04). 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 (84)

The CMS ZIP-to-locality crosswalk maps 84 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 1 span more than one locality and need ZIP+4 for an exact match.

11004 11005 11101 11102 11103 11104 11105 11106 11109 11120 11351 11352 11353 11354 11355 11356 11357 11358 11359 11360 11361 11362 11363 11364 11365 11366 11367 11368 11369 11370 11371 11372 11373 11374 11375 11377 11378 11379 11380 11381 11385 11386 11388 11390 11405 11411 11412 11413 11414 11415 11416 11417 11418 11419 11420 11421 11422 11423 11424 11425 11426 11427 11428 11429 11430 11431 11432 11433 11434 11435 11436 11437 11439 11451 11484 11499 11690 11691 11692 11693 11694 11695 11696 11697
Which ZIP codes does the Queens, NY rate for 99203 cover?

The CMS ZIP-to-locality crosswalk maps 84 ZIP codes to this payment locality, and 99203 has the same amount in every one of them. Examples include 11004, 11005, 11101, 11102, 11103, 11104. Of these, 1 span more than one payment locality and need ZIP+4 for an exact match.

How locality affects the amount Copy link

Office (non-facility) · Q3 2026 · Participating · Whole service

Queens, NY (this locality)
$134.05
National PFS baseline (GPCI 1.000)
$117.57

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Queens, NY 14.0% above the national baseline.

Work GPCI
1.064
Practice expense GPCI
1.182
Malpractice GPCI
1.442
2026 conversion factor
$33.4009
Why is the 99203 rate in Queens, 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 1.182, malpractice 1.442—scale each RVU component before the conversion factor is applied, which is why the Queens, NY amount is higher than the $117.57 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 99203's RVU components is multiplied by its Queens, NY GPCI; the products are summed and multiplied by the conversion factor.

Code
99203
DOS
Not selected; uses this release’s rates
Locality
QUEENS (NY)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q3 2026, revision 1
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 Queens, NY allowed amount for 99203
Component RVU × GPCI = Adjusted
Work 1.60 × 1.064 1.7024
Practice expense · Office (non-facility) 1.76 × 1.182 2.0803
Malpractice 0.16 × 1.442 0.2307
Sum of adjusted RVUs 4.0134
× 33.4009 conversion factor = formula amount $134.05

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

  1. Locality-adjusted allowed amount $134.05

    After applicable fee-schedule adjustments; sequestration excluded

Citations

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

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,949)
    hcpcs (col 1)
    99203
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    1.6
    pe_rvu_nonfacility (col 7)
    1.76
    pe_rvu_facility (col 9)
    0.38
    mp_rvu (col 11)
    0.16

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 81)
    mac (col 1)
    13292
    locality_code (col 3)
    04
    work_gpci (col 5)
    1.064
    pe_gpci (col 6)
    1.182
    mp_gpci (col 7)
    1.442

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 99203 in Queens, NY is $79.57, versus $134.05 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 99203 in Queens, NY?

$79.57 in a facility, versus $134.05 in the Office (non-facility) setting—a $54.48 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 Queens, NY. 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 99203 in Queens, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $134.05
Non-participating allowed amount 95% of the participating amount. $127.35
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $146.45
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $107.24
Patient coinsurance The remaining 20%. $26.81
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $2.14
Net Medicare payment Medicare's share after the sequestration reduction. $105.10
What is the non-participating amount and limiting charge for 99203 in Queens, NY?

A non-participating provider is paid $127.35—95% of the $134.05 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $146.45, which is 115% of the non-participating amount.

How much of the Queens, NY 99203 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($107.24) once the annual Part B deductible is met, and the beneficiary owes 20% ($26.81). Sequestration reduces Medicare's share by about 2% ($2.14), leaving $105.10. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Queens, NY 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—$134.05 in the office (non-facility) setting—not the $117.57 national baseline.

Opens the calculator set to Queens, NY 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 99203 in nearby payment localities

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 99203. Neighboring localities often differ.

99203 allowed amount in payment localities near Queens, NY
Metro Allowed amount vs. Queens, NY
New York City, NY $133.65 -0.3%
Long Island, NY $136.68 +2.0%
Northern New Jersey, NJ $130.71 -2.5%
Philadelphia, PA $121.97 -9.0%
Hartford, CT $124.29 -7.3%
Boston, MA $130.58 -2.6%

Every payment locality nationwide is on the CPT 99203 rate map.

Other codes priced in Queens, NY Copy link

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

Other curated codes and their allowed amounts in Queens, NY
Code and service Allowed vs. national
99213 Routine Follow-Up Office Visit $108.18 +13.6%
99214 Long Follow-Up Office Visit $153.94 +13.5%
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%
99205 Longest New Patient Office Visit $269.24 +13.7%
99202 New Patient Office Visit, Level 2 $85.77 +14.1%
99211 Established Patient Office Visit, Level 1 $28.20 +15.7%
66984 Cataract Surgery $523.23 +13.1%
92014 Full Eye Exam, Returning Patient $145.17 +14.1%
97110 Physical Therapy Exercises $32.66 +12.4%
93010 Heart Tracing Reading $9.29 +11.3%

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. 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 12,949)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 81)
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 99203 in Queens, NY against the release in effect on that date. Dates in the last 12 months don't need an account; older dates of service need a free account.

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