localis

Describe a service in plain words, or type a CPT/HCPCS code.

Rate calculator

Medicare Physician Fee Schedule · Q3 2026 release

CPT 99205 in Austin, TX

Longest new patient office visit in ZIPs including 78701, 78704, and 78731

99205 Q3 2026 · Austin, TX flag04412-31
Locality-adjusted allowed amount
$241.93
in a doctor’s own office or clinic

102.2% of the $236.81 national baseline

( Work3.50 × 1.002 + Practice exp.3.23 × 1.058 + Malpractice0.36 × 0.886 ) × Conv. factor$33.4009 = $241.93

The Medicare allowed amount is $241.93 in the Office (non-facility) setting and $161.01 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 04412-31 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Austin, TX in? Copy link

Austin, TX is in CMS payment locality Austin (04412-31). 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 (89)

The CMS ZIP-to-locality crosswalk maps 89 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 12 span more than one locality and need ZIP+4 for an exact match.

73301 73344 78617 78645 78651 78652 78653 78660 78669 78691 78701 78702 78703 78704 78705 78708 78709 78710 78711 78712 78713 78714 78715 78716 78718 78719 78720 78721 78722 78723 78724 78725 78726 78727 78728 78730 78731 78732 78733 78734 78735 78736 78738 78739 78741 78742 78744 78745 78746 78747 78748 78749 78750 78751 78752 78753 78754 78755 78756 78757 78758 78759 78760 78761 78762 78763 78764 78765 78766 78767 78768 78769 78771 78772 78773 78774 78778 78779 78780 78781 78782 78783 78785 78786 78787 78788 78789 78798 78799
Which ZIP codes does the Austin, TX rate for 99205 cover?

The CMS ZIP-to-locality crosswalk maps 89 ZIP codes to this payment locality, and 99205 has the same amount in every one of them. Examples include 73301, 73344, 78617, 78645, 78651, 78652. Of these, 12 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

Austin, TX (this locality)
$241.93
National PFS baseline (GPCI 1.000)
$236.81

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Austin, TX 2.2% above the national baseline.

Work GPCI
1.002
Practice expense GPCI
1.058
Malpractice GPCI
0.886
2026 conversion factor
$33.4009
Why is the 99205 rate in Austin, TX 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 1.002, practice expense 1.058, malpractice 0.886—scale each RVU component before the conversion factor is applied, which is why the Austin, TX amount is higher than the $236.81 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 99205's RVU components is multiplied by its Austin, TX GPCI; the products are summed and multiplied by the conversion factor.

Code
99205
DOS
Not selected; uses this release’s rates
Locality
AUSTIN (TX)
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 Austin, TX allowed amount for 99205
Component RVU × GPCI = Adjusted
Work 3.50 × 1.002 3.5070
Practice expense · Office (non-facility) 3.23 × 1.058 3.4173
Malpractice 0.36 × 0.886 0.3190
Sum of adjusted RVUs 7.2433
× 33.4009 conversion factor = formula amount $241.93

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

  1. Locality-adjusted allowed amount $241.93

    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 12,951)
    hcpcs (col 1)
    99205
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    3.5
    pe_rvu_nonfacility (col 7)
    3.23
    pe_rvu_facility (col 9)
    0.94
    mp_rvu (col 11)
    0.36

    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 96)
    mac (col 1)
    04412
    locality_code (col 3)
    31
    work_gpci (col 5)
    1.002
    pe_gpci (col 6)
    1.058
    mp_gpci (col 7)
    0.886

    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 99205 in Austin, TX is $161.01, versus $241.93 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 99205 in Austin, TX?

$161.01 in a facility, versus $241.93 in the Office (non-facility) setting—a $80.92 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 Austin, TX. 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 99205 in Austin, TX
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $241.93
Non-participating allowed amount 95% of the participating amount. $229.83
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $264.30
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $193.54
Patient coinsurance The remaining 20%. $48.39
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $3.87
Net Medicare payment Medicare's share after the sequestration reduction. $189.67
What is the non-participating amount and limiting charge for 99205 in Austin, TX?

A non-participating provider is paid $229.83—95% of the $241.93 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $264.30, which is 115% of the non-participating amount.

How much of the Austin, TX 99205 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($193.54) once the annual Part B deductible is met, and the beneficiary owes 20% ($48.39). Sequestration reduces Medicare's share by about 2% ($3.87), leaving $189.67. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Austin, TX 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—$241.93 in the office (non-facility) setting—not the $236.81 national baseline.

Opens the calculator set to Austin, TX 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 99205 in nearby payment localities

Payment localities in the same region as Austin, TX, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 99205. Neighboring localities often differ.

99205 allowed amount in payment localities near Austin, TX
Metro Allowed amount vs. Austin, TX
San Antonio, TX $230.14 -4.9%
Houston, TX $241.51 -0.2%
Dallas, TX $235.73 -2.6%
Fort Worth, TX $234.80 -2.9%
Oklahoma City, OK $222.59 -8.0%
New Orleans, LA $232.08 -4.1%

Every payment locality nationwide is on the CPT 99205 rate map.

Other codes priced in Austin, TX Copy link

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

Other curated codes and their allowed amounts in Austin, TX
Code and service Allowed vs. national
99213 Routine Follow-Up Office Visit $97.77 +2.7%
99214 Long Follow-Up Office Visit $139.08 +2.6%
99204 Long New Patient Office Visit $181.40 +2.3%
99212 Brief Follow-Up Office Visit $61.25 +3.0%
99215 Longest Follow-Up Office Visit $197.10 +2.4%
99203 New Patient Office Visit $120.48 +2.5%
99202 New Patient Office Visit, Level 2 $77.37 +3.0%
99211 Established Patient Office Visit, Level 1 $25.40 +4.2%
66984 Cataract Surgery $472.92 +2.2%
92014 Full Eye Exam, Returning Patient $131.75 +3.5%
97110 Physical Therapy Exercises $29.85 +2.7%
93010 Heart Tracing Reading $8.46 +1.3%

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 04412-31'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 12,951)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 96)
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 99205 in Austin, TX 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.

Did this answer your question about CPT 99205 in Austin, TX?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.

Did this page answer your question?