Los Angeles, CA (Locality 01182-18)
8.3% above the national baseline ($86.84)
Los Angeles, CA (Locality 01182-18)
5.1% above the national baseline ($65.80)
CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work1.50 × 1.041 + Practice exp.1.01 × 1.183 + Malpractice0.09 × 0.664 ) × Conv. factor$33.4009 = $94.06
F Work RVU
1.50
G Non‑facility PE RVU
1.01
K MP RVU
0.09
Z Conversion factor
33.4009
E Work GPCI
1.041
F PE GPCI
1.183
G MP GPCI
0.664
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 13,161 in rvu26d-updated-08-26-2026.zip Download from CMS
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 13 in rvu26d-updated-08-26-2026.zip Download from CMS
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CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work1.50 × 1.041 + Practice exp.0.38 × 1.183 + Malpractice0.09 × 0.664 ) × Conv. factor$33.4009 = $69.17
F Work RVU
1.50
I Facility PE RVU
0.38
K MP RVU
0.09
Z Conversion factor
33.4009
E Work GPCI
1.041
F PE GPCI
1.183
G MP GPCI
0.664
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 13,161 in rvu26d-updated-08-26-2026.zip Download from CMS
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 13 in rvu26d-updated-08-26-2026.zip Download from CMS
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The Medicare allowed amount is $94.06 in the Office (non-facility) setting and $69.17 in a facility, under the Q4 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.
Assumes a participating provider, no modifiers, the whole service, before sequestration.
Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method
What Medicare locality is Los Angeles, CA in? Copy link
Los Angeles, CA is in CMS payment locality Los Angeles-Long Beach-Anaheim (Los Angeles/Orange County). The same amount applies across the whole locality, including Long Beach and Anaheim.
Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.
ZIP codes in this payment locality (691)
The CMS ZIP-to-locality crosswalk maps 691 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 6 span more than one locality and need ZIP+4 for an exact match.
591 more ZIP codes map to this locality. The Los Angeles, CA locality page lists the full set.
Which ZIP codes does the Los Angeles, CA rate for 99497 cover?
The CMS ZIP-to-locality crosswalk maps 691 ZIP codes to this payment locality, and 99497 has the same amount in every one of them. Examples include 90001, 90002, 90003, 90004, 90005, 90006. Of these, 6 span more than one payment locality and need ZIP+4 for an exact match.
Which cities does the Los Angeles, CA rate for 99497 cover?
This payment locality also covers Long Beach and Anaheim. 99497 has the same amount everywhere in it—the label names the largest metro, not a city-specific amount.
How locality affects the amount Copy link
Office (non-facility) · Q4 2026 · Participating · Whole service
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Los Angeles, CA 8.3% above the national baseline.
Los Angeles, CA ranks #16 of 109 Medicare payment localities for 99497, where #1 has the highest allowed amount. Within California it's #8 of 29: $4.52 (5.0%) higher than Rest of California ($89.54).
Each figure is that GPCI's share of the +$7.22 gap from the national baseline: its RVUs for 99497 × (GPCI − 1.000) × the conversion factor. Practice expense accounts for the most, +$6.17.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Why is the 99497 rate in Los Angeles, 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 1.041, practice expense 1.183, malpractice 0.664—scale each RVU component before the conversion factor is applied, which is why the Los Angeles, CA amount is higher than the $86.84 baseline.
99497 in Los Angeles, CA since Q4 2025 Copy link
Office (non-facility) · Participating · Whole service
The allowed amount went from $86.00 in Q4 2025 to $94.06 in Q4 2026, +$8.06 (+9.4%). The national baseline moved +9.1% over the same period.
| Conversion factor National: the dollar multiplier CMS sets each year. | +$2.80 |
|---|---|
| 99497's RVUs National: CMS revalued the code itself. | +$5.75 |
| Los Angeles, CA's GPCIs Local: this payment locality's cost indices. | -$0.49 |
| Total change | +$8.06 |
A derived breakdown of the two releases' formula inputs, applied in order: the conversion factor on Q4 2025's RVUs and GPCIs, then 99497's new RVUs, then this locality's new GPCIs. A different order moves a few cents between rows; the total is exact.
Formula and inputs Copy link
For the office (non-facility) amount, each of 99497's RVU components is multiplied by its Los Angeles, CA GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 99497
- DOS
- Not selected; uses this release’s rates
- Locality
- LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q4 2026, revision 2
- 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.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 1.50 | × 1.041 | 1.5615 |
| Practice expense · Office (non-facility) | 1.01 | × 1.183 | 1.1948 |
| Malpractice | 0.09 | × 0.664 | 0.0598 |
| Sum of adjusted RVUs | 2.8161 | ||
| × 33.4009 conversion factor = formula amount | $94.06 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
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Locality-adjusted allowed amount $94.06
After applicable fee-schedule adjustments; sequestration excluded
Citations
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99497’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 13,161 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 99497
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 1.50
- G Non-facility PE RVU
- 1.01
- K MP RVU
- 0.09
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 13,159–13,163 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 01182-18’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 13 in rvu26d-updated-08-26-2026.zip
- A MAC
- 01182
- C Locality number
- 18
- E Work GPCI
- 1.041
- F PE GPCI
- 1.183
- G MP GPCI
- 0.664
In the CMS file
Loading rows 11–15 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
CMS RVU26DOctober 1 – December 31, 2026revision 2
Facility vs. Office (non-facility) Copy link
In a facility (hospital outpatient department or ASC), the allowed amount for 99497 in Los Angeles, CA is $69.17, versus $94.06 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 99497 in Los Angeles, CA?
$69.17 in a facility, versus $94.06 in the Office (non-facility) setting—a $24.89 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 Los Angeles, 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.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $94.06 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $89.36 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $102.76 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $75.25 |
| Patient coinsurance The remaining 20%. | $18.81 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $1.51 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $73.74 |
What is the non-participating amount and limiting charge for 99497 in Los Angeles, CA?
A non-participating provider is paid $89.36—95% of the $94.06 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $102.76, which is 115% of the non-participating amount.
How much of the Los Angeles, CA 99497 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($75.25) once the annual Part B deductible is met, and the beneficiary owes 20% ($18.81). Sequestration reduces Medicare's share by about 2% ($1.51), leaving $73.74. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in Los Angeles, 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—$94.06 in the office (non-facility) setting—not the $86.84 national baseline.
Opens the calculator set to Los Angeles, 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.
99497 in nearby payment localities Copy link
Payment localities in the same region as Los Angeles, CA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 99497. Neighboring localities often differ.
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Los Angeles, CA · this page $94.06
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Ventura County, CA $93.25 -0.9%
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Riverside, CA $90.54 -3.7%
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San Diego, CA $93.58 -0.5%
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Bakersfield, CA $89.86 -4.5%
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Fresno, CA $89.54 -4.8%
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San Jose, CA $105.45 +12.1%
Percentages are against Los Angeles, CA. Every payment locality nationwide is on the CPT 99497 rate map.
Other codes priced in Los Angeles, CA Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 99213 Routine Follow-Up Office Visit | $104.89 | +10.2% |
| 99214 Long Follow-Up Office Visit | $148.89 | +9.8% |
| 66984 Cataract Surgery | $503.89 | +8.9% |
| 92014 Full Eye Exam, Returning Patient | $143.12 | +12.5% |
| 99204 Long New Patient Office Visit | $193.32 | +9.0% |
| 99215 Longest Follow-Up Office Visit | $210.68 | +9.5% |
| 97110 Physical Therapy Exercises | $32.07 | +10.4% |
| 99203 New Patient Office Visit | $128.72 | +9.5% |
| 93000 Heart Tracing | $17.02 | +10.8% |
| 93306 Heart Ultrasound | $224.61 | +14.2% |
| 77067 Screening Mammogram | $144.98 | +14.8% |
| 27447 Knee Replacement | $1,211.18 | +4.5% |
Source & method Copy link
Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 01182-18's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 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.
Working a claim with an earlier date of service? The calculator prices 99497 in Los Angeles, CA against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.
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