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Medicare Physician Fee Schedule · Q4 2026 release

HCPCS G0121 in Louisville, KY

Colon ca scrn not hi rsk ind in ZIPs including 40202, 40507, and 40203

G0121 Q4 2026 · Louisville, KY flag15102-00
Locality-adjusted allowed amount
$348.58
in a doctor’s own office or clinic

92.1% of the $378.43 national baseline

( Work3.18 × 1.000 + Practice exp.7.73 × 0.889 + Malpractice0.42 × 0.915 ) × Conv. factor$33.4009 = $348.58

The Medicare allowed amount is $348.58 in the Office (non-facility) setting and $158.84 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.

Q4 2026 · Locality 15102-00 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Louisville, KY in? Copy link

CMS prices all of Kentucky as one Medicare payment locality, so this amount applies statewide, including Lexington, Bowling Green and Covington—not only in Louisville, KY.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (1,030)

The CMS ZIP-to-locality crosswalk maps 1,030 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 2 span more than one locality and need ZIP+4 for an exact match.

40003 40004 40006 40007 40008 40009 40010 40011 40012 40013 40014 40018 40019 40020 40022 40023 40025 40026 40027 40031 40032 40033 40036 40037 40040 40041 40045 40046 40047 40048 40049 40050 40051 40052 40055 40056 40057 40058 40059 40060 40061 40062 40063 40065 40066 40067 40068 40069 40070 40071 40075 40076 40077 40078 40104 40106 40107 40108 40109 40110 40111 40115 40117 40118 40119 40121 40122 40129 40140 40142 40143 40144 40145 40146 40150 40152 40153 40155 40157 40159 40160 40161 40162 40164 40165 40166 40170 40171 40175 40176 40177 40178 40201 40202 40203 40204 40205 40206 40207 40208

930 more ZIP codes map to this locality. The Louisville, KY locality page lists the full set.

Which ZIP codes does the Louisville, KY rate for G0121 cover?

The CMS ZIP-to-locality crosswalk maps 1,030 ZIP codes to this payment locality, and G0121 has the same amount in every one of them. Examples include 40003, 40004, 40006, 40007, 40008, 40009. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.

Does this G0121 rate apply everywhere in Kentucky?

Yes. CMS prices Kentucky as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Louisville, KY. That includes Lexington, Bowling Green and Covington. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Louisville, KY (this locality)
$348.58
National PFS baseline (GPCI 1.000)
$378.43

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Louisville, KY 7.9% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.889
Malpractice GPCI
0.915
2026 conversion factor
$33.4009
Why is the G0121 rate in Louisville, KY 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 1.000, practice expense 0.889, malpractice 0.915—scale each RVU component before the conversion factor is applied, which is why the Louisville, KY amount is lower than the $378.43 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of G0121's RVU components is multiplied by its Louisville, KY GPCI; the products are summed and multiplied by the conversion factor.

Code
G0121
DOS
Not selected; uses this release’s rates
Locality
KENTUCKY (KY)
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.

RVU × GPCI components of Louisville, KY allowed amount for G0121
Component RVU × GPCI = Adjusted
Work 3.18 × 1.000 3.1800
Practice expense · Office (non-facility) 7.73 × 0.889 6.8720
Malpractice 0.42 × 0.915 0.3843
Sum of adjusted RVUs 10.4363
× 33.4009 conversion factor = formula amount $348.58

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

  1. Locality-adjusted allowed amount $348.58

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • Supplies the RVUs and PFS status for this code and component.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 15,093)
    hcpcs (col 1)
    G0121
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    3.18
    pe_rvu_nonfacility (col 7)
    7.73
    pe_rvu_facility (col 9)
    1.34
    mp_rvu (col 11)
    0.42

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details GPCI2026.csv in rvu26d-updated-08-26-2026.zip (row 55)
    mac (col 1)
    15102
    locality_code (col 3)
    00
    work_gpci (col 5)
    1
    pe_gpci (col 6)
    0.889
    mp_gpci (col 7)
    0.915

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for G0121 in Louisville, KY is $158.84, versus $348.58 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 G0121 in Louisville, KY?

$158.84 in a facility, versus $348.58 in the Office (non-facility) setting—a $189.74 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 Louisville, KY. 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 G0121 in Louisville, KY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $348.58
Non-participating allowed amount 95% of the participating amount. $331.15
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $380.82
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $278.86
Patient coinsurance The remaining 20%. $69.72
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $5.58
Net Medicare payment Medicare's share after the sequestration reduction. $273.28
What is the non-participating amount and limiting charge for G0121 in Louisville, KY?

A non-participating provider is paid $331.15—95% of the $348.58 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $380.82, which is 115% of the non-participating amount.

How much of the Louisville, KY G0121 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($278.86) once the annual Part B deductible is met, and the beneficiary owes 20% ($69.72). Sequestration reduces Medicare's share by about 2% ($5.58), leaving $273.28. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Louisville, KY 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—$348.58 in the office (non-facility) setting—not the $378.43 national baseline.

Opens the calculator set to Louisville, KY 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 G0121 in nearby payment localities

Payment localities in the same region as Louisville, KY, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for G0121. Neighboring localities often differ.

G0121 allowed amount in payment localities near Louisville, KY
Metro Allowed amount vs. Louisville, KY
Indianapolis, IN $352.37 +1.1%
Nashville, TN $348.44 —
Columbus, OH $356.08 +2.2%
St. Louis, MO $366.07 +5.0%
Chicago, IL $398.63 +14.4%
Detroit, MI $379.02 +8.7%

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

Other codes priced in Louisville, KY Copy link

Office (non-facility) allowed amounts in this same payment locality, Q4 2026.

Other curated codes and their allowed amounts in Louisville, KY
Code and service Allowed vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $381.23 -9.0%
45385 Colonoscopy With Polyp Removal $461.49 -7.7%
45380 Colonoscopy With Tissue Sampling $439.92 -8.3%
45378 Diagnostic Colonoscopy $348.28 -7.9%
43235 Screening and endoscopy $294.61 -8.7%
45384 Screening and endoscopy $494.80 -8.3%
45381 Screening and endoscopy $449.13 -8.4%
G0105 Screening and endoscopy $348.28 -7.9%
99213 Routine Follow-Up Office Visit $89.52 -6.0%
99214 Long Follow-Up Office Visit $127.80 -5.8%
66984 Cataract Surgery $438.31 -5.3%
92014 Full Eye Exam, Returning Patient $118.43 -6.9%

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 15102-00'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.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 15,093)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 55)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices G0121 in Louisville, KY 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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