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Medicare Physician Fee Schedule · Q3 2026 release

HCPCS G0121 in Denver, CO 04112-01

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G0121 2026 C · Denver, CO flag04112-01 A Active
Allowed amount
$393.16
in a doctor’s own office or clinic

103.9% of the $378.43 national baseline

Medicare payment
$314.53
Patient / secondary
$78.63
Expected total to provider
$393.16

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 HCPCS G0121 in Denver, CO? Copy link

The Medicare allowed amount is $393.16 in the office (non-facility) setting and $166.07 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 3.9% above the national baseline, and the facility amount is 0.6% 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 Denver, CO in? Copy link

CMS prices all of Colorado as one Medicare payment locality, so this amount applies statewide, including Colorado Springs, Aurora and Fort Collins — not only in Denver, CO.

Why Denver, CO differs from the national amount Copy link

Denver, CO (this locality)
$393.16
National PFS baseline (GPCI 1.000)
$378.43

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 Denver, CO at 3.9% above the national baseline.

Work GPCI
1.012
Practice expense GPCI
1.064
Malpractice GPCI
0.781
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for G0121 in Denver, CO: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Denver, CO allowed amount for G0121
Component RVU × GPCI = Adjusted RVU
Work 3.18 1.012 3.2182
Practice expense 7.73 1.064 8.2247
Malpractice 0.42 0.781 0.3280
Sum of adjusted RVUs 11.7709
× $33.4009 2026 conversion factor $393.16

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Denver, CO allows $166.07 for G0121, versus $393.16 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 Denver, CO. 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 G0121 in Denver, CO
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $393.16
Non-participating allowed amount 95% of the participating amount. $373.50
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $429.53
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $314.53
Beneficiary coinsurance The remaining 20%. $78.63
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $6.29
Medicare pays after sequestration Program payment net of the sequestration reduction. $308.24

Contracted rate: % of Medicare in Denver, CO 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 — $393.16 in the office (non-facility) setting — not the $378.43 national baseline.

Opens the calculator already set to Denver, CO 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 Denver, CO rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 677 ZIP codes to this payment locality. G0121 prices identically in every one of them. 2 of them span more than one locality and need ZIP+4 for an exact match.

80001 80002 80003 80004 80005 80006 80007 80010 80011 80012 80013 80014 80015 80016 80017 80018 80019 80020 80021 80022 80023 80024 80025 80026 80027 80028 80030 80031 80033 80034 80035 80036 80037 80038 80040 80041 80042 80044 80045 80046 80047 80101 80102 80103 80104 80105 80106 80107 80108 80109 80110 80111 80112 80113 80116 80117 80118 80120 80121 80122 80123 80124 80125 80126 80127 80128 80129 80130 80131 80132 80133 80134 80135 80136 80137 80138 80150 80151 80154 80155 80160 80161 80162 80163 80165 80166 80201 80202 80203 80204 80205 80206 80207 80208 80209 80210 80211 80212 80214 80215

577 more ZIP codes map to this locality. The Denver, CO locality page lists the full set.

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

G0121 in nearby payment localities Copy link

Payment localities in the same region as Denver, CO, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for G0121. Proximity doesn't imply similar pricing — neighbouring localities often differ.

G0121 allowed amount in payment localities near Denver, CO
Metro Allowed amount vs. Denver, CO
Salt Lake City, UT $361.51 -8.1%
Albuquerque, NM $359.82 -8.5%
Wichita, KS $346.69 -11.8%
Omaha, NE $349.83 -11.0%
Oklahoma City, OK $347.68 -11.6%
Phoenix, AZ $368.41 -6.3%

Every payment locality nationwide is on the HCPCS G0121 rate map.

Other codes priced in Denver, CO Copy link

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

Other curated codes and their allowed amounts in Denver, CO
Code Service Denver, CO vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $439.05 +4.8%
45385 Colonoscopy With Polyp Removal $519.45 +3.9%
45380 Colonoscopy With Tissue Sampling $500.69 +4.3%
45378 Diagnostic Colonoscopy $392.90 +3.9%
43235 Screening and endoscopy $337.49 +4.6%
45384 Screening and endoscopy $561.29 +4.1%
45381 Screening and endoscopy $511.71 +4.4%
G0105 Screening and endoscopy $392.90 +3.9%
99213 Routine Follow-Up Office Visit $98.18 +3.1%
99214 Long Follow-Up Office Visit $139.63 +3.0%
66984 Cataract Surgery $474.65 +2.6%
92014 Full Eye Exam, Returning Patient $132.56 +4.2%

Common questions Copy link

Which ZIP codes does the Denver, CO rate for G0121 cover?
The CMS ZIP-to-locality crosswalk maps 677 ZIP codes to this payment locality, and every one of them prices G0121 identically. Examples include 80001, 80002, 80003, 80004, 80005, 80006. 2 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the G0121 rate in Denver, CO 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 1.012, practice expense 1.064, malpractice 0.781 — scale each RVU component before the conversion factor is applied, which is why Denver, CO allows more than the $378.43 baseline.
Does this G0121 rate apply everywhere in Colorado?
Yes. CMS prices Colorado as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Denver, CO. That includes Colorado Springs, Aurora and Fort Collins. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.
What is the facility rate for G0121 in Denver, CO?
$166.07 in a facility, versus $393.16 in the office (non-facility) setting — a $227.09 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 G0121 in Denver, CO?
A non-participating provider is paid $373.50 — 95% of the $393.16 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $429.53, which is 115% of the non-participating amount.
How much of the Denver, CO G0121 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($314.53) once the annual Part B deductible is met, and the beneficiary owes 20% ($78.63). Sequestration reduces Medicare's share by about 2% ($6.29), leaving $308.24. 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 04112-01'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 15,024)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 37)
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 G0121 in Denver, CO against the release that governed that date. Past releases need a free account; today's rate does not.

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