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Medicare Physician Fee Schedule · Q3 2026 release

CPT 99215 in Queens, NY 13292-04

Longest follow-up office visit in ZIPs including 11101, 11354, and 11375

99215 2026 C · Queens, NY flag13292-04 A Active
Allowed amount
$218.19
in a doctor’s own office or clinic

113.4% of the $192.39 national baseline

Medicare payment
$174.55
Patient / secondary
$43.64
Expected total to provider
$218.19

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 99215 in Queens, NY? Copy link

The Medicare allowed amount is $218.19 in the office (non-facility) setting and $139.23 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 13.4% above the national baseline, and the facility amount is 10.9% 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 Queens, NY in? Copy link

CMS payment locality Queens (13292-04). Every location in it is priced identically.

Why Queens, NY differs from the national amount Copy link

Queens, NY (this locality)
$218.19
National PFS baseline (GPCI 1.000)
$192.39

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 Queens, NY at 13.4% above the national baseline.

Work GPCI
1.064
Practice expense GPCI
1.182
Malpractice GPCI
1.442
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 99215 in Queens, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Queens, NY allowed amount for 99215
Component RVU × GPCI = Adjusted RVU
Work 2.80 1.064 2.9792
Practice expense 2.75 1.182 3.2505
Malpractice 0.21 1.442 0.3028
Sum of adjusted RVUs 6.5325
× $33.4009 2026 conversion factor $218.19

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Queens, NY allows $139.23 for 99215, versus $218.19 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 Queens, 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 99215 in Queens, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $218.19
Non-participating allowed amount 95% of the participating amount. $207.28
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $238.37
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $174.55
Beneficiary coinsurance The remaining 20%. $43.64
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $3.49
Medicare pays after sequestration Program payment net of the sequestration reduction. $171.06

Contracted rate: % of Medicare in Queens, 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 — $218.19 in the office (non-facility) setting — not the $192.39 national baseline.

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

The CMS ZIP-to-locality crosswalk maps 84 ZIP codes to this payment locality. 99215 prices identically in every one of them. 1 of them 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

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

99215 in nearby payment localities Copy link

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 99215. Proximity doesn't imply similar pricing — neighbouring localities often differ.

99215 allowed amount in payment localities near Queens, NY
Metro Allowed amount vs. Queens, NY
New York City, NY $217.37 -0.4%
Long Island, NY $221.75 +1.6%
Northern New Jersey, NJ $213.45 -2.2%
Philadelphia, PA $199.19 -8.7%
Hartford, CT $202.81 -7.0%
Boston, MA $213.27 -2.3%

Every payment locality nationwide is on the CPT 99215 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 Service Queens, NY 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%
99203 New Patient Office Visit $134.05 +14.0%
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%

Common questions Copy link

Which ZIP codes does the Queens, NY rate for 99215 cover?
The CMS ZIP-to-locality crosswalk maps 84 ZIP codes to this payment locality, and every one of them prices 99215 identically. Examples include 11004, 11005, 11101, 11102, 11103, 11104. 1 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 99215 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 Queens, NY allows more than the $192.39 baseline.
What is the facility rate for 99215 in Queens, NY?
$139.23 in a facility, versus $218.19 in the office (non-facility) setting — a $78.96 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 99215 in Queens, NY?
A non-participating provider is paid $207.28 — 95% of the $218.19 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $238.37, which is 115% of the non-participating amount.
How much of the Queens, NY 99215 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($174.55) once the annual Part B deductible is met, and the beneficiary owes 20% ($43.64). Sequestration reduces Medicare's share by about 2% ($3.49), leaving $171.06. 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 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 . 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 12,956)
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 99215 in Queens, NY against the release that governed that date. Past releases need a free account; today's rate does not.

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