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Medicare Physician Fee Schedule · Q3 2026 release

CPT 99213 in Fresno, CA

Routine follow-up office visit in ZIPs including 93721, 93704, and 93650

99213 Q3 2026 · Fresno, CA flag01112-56
Locality-adjusted allowed amount
$99.22
in a doctor’s own office or clinic

104.2% of the $95.19 national baseline

( Work1.30 × 1.017 + Practice exp.1.46 × 1.096 + Malpractice0.09 × 0.536 ) × Conv. factor$33.4009 = $99.22

The Medicare allowed amount is $99.22 in the Office (non-facility) setting and $57.85 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 01112-56 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Fresno, CA in? Copy link

Fresno, CA is in CMS payment locality Fresno (01112-56). 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 (105)

The CMS ZIP-to-locality crosswalk maps 105 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 11 span more than one locality and need ZIP+4 for an exact match.

93210 93234 93242 93602 93605 93606 93607 93608 93609 93611 93612 93613 93616 93619 93621 93622 93624 93625 93626 93627 93628 93629 93630 93631 93634 93640 93641 93642 93646 93648 93649 93650 93651 93652 93654 93656 93657 93660 93662 93664 93667 93668 93675 93701 93702 93703 93704 93705 93706 93707 93708 93709 93710 93711 93712 93714 93715 93716 93717 93718 93720 93721 93722 93723 93724 93725 93726 93727 93728 93729 93730 93737 93740 93741 93744 93745 93747 93750 93755 93759 93760 93761 93762 93764 93765 93771 93772 93773 93774 93775 93776 93777 93778 93779 93780 93782 93784 93786 93790 93791

5 more ZIP codes map to this locality. The Fresno, CA locality page lists the full set.

Which ZIP codes does the Fresno, CA rate for 99213 cover?

The CMS ZIP-to-locality crosswalk maps 105 ZIP codes to this payment locality, and 99213 has the same amount in every one of them. Examples include 93210, 93234, 93242, 93602, 93605, 93606. Of these, 11 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

Fresno, CA (this locality)
$99.22
National PFS baseline (GPCI 1.000)
$95.19

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Fresno, CA 4.2% above the national baseline.

Work GPCI
1.017
Practice expense GPCI
1.096
Malpractice GPCI
0.536
2026 conversion factor
$33.4009
Why is the 99213 rate in Fresno, CA 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 1.017, practice expense 1.096, malpractice 0.536—scale each RVU component before the conversion factor is applied, which is why the Fresno, CA amount is higher than the $95.19 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 99213's RVU components is multiplied by its Fresno, CA GPCI; the products are summed and multiplied by the conversion factor.

Code
99213
DOS
Not selected; uses this release’s rates
Locality
FRESNO (CA)
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 Fresno, CA allowed amount for 99213
Component RVU × GPCI = Adjusted
Work 1.30 × 1.017 1.3221
Practice expense · Office (non-facility) 1.46 × 1.096 1.6002
Malpractice 0.09 × 0.536 0.0482
Sum of adjusted RVUs 2.9705
× 33.4009 conversion factor = formula amount $99.22

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

  1. Locality-adjusted allowed amount $99.22

    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 12,954)
    hcpcs (col 1)
    99213
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    1.3
    pe_rvu_nonfacility (col 7)
    1.46
    pe_rvu_facility (col 9)
    0.33
    mp_rvu (col 11)
    0.09

    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 11)
    mac (col 1)
    01112
    locality_code (col 3)
    56
    work_gpci (col 5)
    1.017
    pe_gpci (col 6)
    1.096
    mp_gpci (col 7)
    0.536

    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 99213 in Fresno, CA is $57.85, versus $99.22 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 99213 in Fresno, CA?

$57.85 in a facility, versus $99.22 in the Office (non-facility) setting—a $41.37 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 Fresno, CA. 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 99213 in Fresno, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $99.22
Non-participating allowed amount 95% of the participating amount. $94.26
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $108.40
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $79.38
Patient coinsurance The remaining 20%. $19.84
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $1.59
Net Medicare payment Medicare's share after the sequestration reduction. $77.79
What is the non-participating amount and limiting charge for 99213 in Fresno, CA?

A non-participating provider is paid $94.26—95% of the $99.22 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $108.40, which is 115% of the non-participating amount.

How much of the Fresno, CA 99213 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($79.38) once the annual Part B deductible is met, and the beneficiary owes 20% ($19.84). Sequestration reduces Medicare's share by about 2% ($1.59), leaving $77.79. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Fresno, CA 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—$99.22 in the office (non-facility) setting—not the $95.19 national baseline.

Opens the calculator set to Fresno, CA 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 99213 in nearby payment localities

Payment localities in the same region as Fresno, CA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 99213. Neighboring localities often differ.

99213 allowed amount in payment localities near Fresno, CA
Metro Allowed amount vs. Fresno, CA
Bakersfield, CA $99.52 +0.3%
San Jose, CA $119.71 +20.7%
Sacramento, CA $103.31 +4.1%
San Francisco, CA $117.58 +18.5%
Ventura County, CA $104.15 +5.0%
Los Angeles, CA $104.89 +5.7%

Every payment locality nationwide is on the CPT 99213 rate map.

Other codes priced in Fresno, CA Copy link

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

Other curated codes and their allowed amounts in Fresno, CA
Code and service Allowed vs. national
99214 Long Follow-Up Office Visit $140.94 +3.9%
99204 Long New Patient Office Visit $183.04 +3.2%
99212 Brief Follow-Up Office Visit $62.19 +4.6%
99215 Longest Follow-Up Office Visit $199.54 +3.7%
99203 New Patient Office Visit $121.64 +3.5%
99205 Longest New Patient Office Visit $243.58 +2.9%
99202 New Patient Office Visit, Level 2 $78.60 +4.6%
99211 Established Patient Office Visit, Level 1 $26.06 +6.9%
66984 Cataract Surgery $477.99 +3.3%
92014 Full Eye Exam, Returning Patient $134.98 +6.1%
97110 Physical Therapy Exercises $30.47 +4.9%
93010 Heart Tracing Reading $8.52 +2.0%

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 01112-56'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 12,954)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 11)
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 99213 in Fresno, CA 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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