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Medicare Physician Fee Schedule · Q3 2026 release

HCPCS G0121 in Washington, DC 12202-01

Colon ca scrn not hi rsk ind in ZIPs including 20001, 20004, and 22201

G0121 2026 C · Washington, DC flag12202-01 A Active
Allowed amount
$431.71
in a doctor’s own office or clinic

114.1% of the $378.43 national baseline

Medicare payment
$345.37
Patient / secondary
$86.34
Expected total to provider
$431.71

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 Washington, DC? Copy link

The Medicare allowed amount is $431.71 in the office (non-facility) setting and $180.29 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 14.1% above the national baseline, and the facility amount is 9.3% 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 Washington, DC in? Copy link

CMS prices all of District of Columbia as one Medicare payment locality (Dc + Md/Va Suburbs), so this amount applies statewide — not only in Washington, DC.

Why Washington, DC differs from the national amount Copy link

Washington, DC (this locality)
$431.71
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 Washington, DC at 14.1% above the national baseline.

Work GPCI
1.054
Practice expense GPCI
1.178
Malpractice GPCI
1.113
2026 conversion factor
$33.4009

Formula and inputs Copy link

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

RVU and GPCI components of the Washington, DC allowed amount for G0121
Component RVU × GPCI = Adjusted RVU
Work 3.18 1.054 3.3517
Practice expense 7.73 1.178 9.1059
Malpractice 0.42 1.113 0.4675
Sum of adjusted RVUs 12.9251
× $33.4009 2026 conversion factor $431.71

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Washington, DC allows $180.29 for G0121, versus $431.71 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 Washington, DC. 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 Washington, DC
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $431.71
Non-participating allowed amount 95% of the participating amount. $410.12
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $471.64
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $345.37
Beneficiary coinsurance The remaining 20%. $86.34
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $6.91
Medicare pays after sequestration Program payment net of the sequestration reduction. $338.46

Contracted rate: % of Medicare in Washington, DC 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 — $431.71 in the office (non-facility) setting — not the $378.43 national baseline.

Opens the calculator already set to Washington, DC 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 Washington, DC rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 591 ZIP codes to this payment locality, across DC, MD, VA. G0121 prices identically in every one of them. 7 of them span more than one locality and need ZIP+4 for an exact match.

20001 20002 20003 20004 20005 20006 20007 20008 20009 20010 20011 20012 20013 20015 20016 20017 20018 20019 20020 20022 20023 20024 20026 20027 20029 20030 20032 20033 20035 20036 20037 20038 20039 20040 20041 20042 20043 20044 20045 20046 20047 20049 20050 20051 20052 20053 20055 20056 20057 20058 20059 20060 20061 20062 20063 20064 20065 20066 20067 20068 20069 20070 20071 20073 20074 20075 20076 20077 20078 20080 20081 20082 20088 20090 20091 20097 20098 20099 20120 20121 20122 20124 20151 20153 20170 20171 20172 20190 20191 20192 20193 20194 20195 20196 20201 20202 20203 20204 20206 20207

491 more ZIP codes map to this locality. The Washington, DC 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 Washington, DC, 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 Washington, DC
Metro Allowed amount vs. Washington, DC
Baltimore, MD $402.30 -6.8%
Richmond, VA $369.92 -14.3%
Philadelphia, PA $393.64 -8.8%
Pittsburgh, PA $356.49 -17.4%
Charlotte, NC $356.07 -17.5%
New York City, NY $435.28 +0.8%

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

Other codes priced in Washington, DC Copy link

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

Other curated codes and their allowed amounts in Washington, DC
Code Service Washington, DC vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $483.17 +15.4%
45385 Colonoscopy With Polyp Removal $569.43 +13.9%
45380 Colonoscopy With Tissue Sampling $550.12 +14.6%
45378 Diagnostic Colonoscopy $431.34 +14.1%
43235 Screening and endoscopy $371.11 +15.0%
45384 Screening and endoscopy $617.68 +14.5%
45381 Screening and endoscopy $562.32 +14.7%
G0105 Screening and endoscopy $431.34 +14.1%
99213 Routine Follow-Up Office Visit $106.56 +11.9%
99214 Long Follow-Up Office Visit $151.49 +11.7%
66984 Cataract Surgery $514.08 +11.1%
92014 Full Eye Exam, Returning Patient $143.94 +13.1%

Common questions Copy link

Which ZIP codes does the Washington, DC rate for G0121 cover?
The CMS ZIP-to-locality crosswalk maps 591 ZIP codes to this payment locality, and every one of them prices G0121 identically. Examples include 20001, 20002, 20003, 20004, 20005, 20006. The locality spans DC, MD, VA. 7 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the G0121 rate in Washington, DC 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 1.054, practice expense 1.178, malpractice 1.113 — scale each RVU component before the conversion factor is applied, which is why Washington, DC allows more than the $378.43 baseline.
Does this G0121 rate apply everywhere in District of Columbia?
Yes. CMS prices District of Columbia as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Washington, DC. 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 Washington, DC?
$180.29 in a facility, versus $431.71 in the office (non-facility) setting — a $251.42 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 Washington, DC?
A non-participating provider is paid $410.12 — 95% of the $431.71 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $471.64, which is 115% of the non-participating amount.
How much of the Washington, DC G0121 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($345.37) once the annual Part B deductible is met, and the beneficiary owes 20% ($86.34). Sequestration reduces Medicare's share by about 2% ($6.91), leaving $338.46. 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 12202-01'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 39)
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 Washington, DC against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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