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Medicare Physician Fee Schedule · Q3 2026 release

HCPCS G0121 in Detroit, MI 08202-01

Colon ca scrn not hi rsk ind in ZIPs including 48226, 48201, and 48207

G0121 2026 C · Detroit, MI flag08202-01 A Active
Allowed amount
$379.02
in a doctor’s own office or clinic

100.2% of the $378.43 national baseline

Medicare payment
$303.22
Patient / secondary
$75.80
Expected total to provider
$379.02

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 Detroit, MI? Copy link

The Medicare allowed amount is $379.02 in the office (non-facility) setting and $173.06 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 0.2% above the national baseline, and the facility amount is 4.9% 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 Detroit, MI in? Copy link

CMS payment locality Detroit (08202-01). Every location in it is priced identically.

Why Detroit, MI differs from the national amount Copy link

Detroit, MI (this locality)
$379.02
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 Detroit, MI at 0.2% above the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.965
Malpractice GPCI
1.686
2026 conversion factor
$33.4009

Formula and inputs Copy link

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

RVU and GPCI components of the Detroit, MI allowed amount for G0121
Component RVU × GPCI = Adjusted RVU
Work 3.18 1.000 3.1800
Practice expense 7.73 0.965 7.4595
Malpractice 0.42 1.686 0.7081
Sum of adjusted RVUs 11.3476
× $33.4009 2026 conversion factor $379.02

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Detroit, MI allows $173.06 for G0121, versus $379.02 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 Detroit, MI. 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 Detroit, MI
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $379.02
Non-participating allowed amount 95% of the participating amount. $360.07
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $414.08
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $303.22
Beneficiary coinsurance The remaining 20%. $75.80
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $6.06
Medicare pays after sequestration Program payment net of the sequestration reduction. $297.16

Contracted rate: % of Medicare in Detroit, MI 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 — $379.02 in the office (non-facility) setting — not the $378.43 national baseline.

Opens the calculator already set to Detroit, MI 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 Detroit, MI rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 250 ZIP codes to this payment locality. G0121 prices identically in every one of them. 8 of them span more than one locality and need ZIP+4 for an exact match.

48005 48007 48009 48012 48015 48017 48021 48025 48026 48030 48033 48034 48035 48036 48037 48038 48042 48043 48044 48045 48046 48047 48048 48050 48051 48055 48062 48065 48066 48067 48068 48069 48070 48071 48072 48073 48075 48076 48080 48081 48082 48083 48084 48085 48086 48088 48089 48090 48091 48092 48093 48094 48095 48096 48098 48099 48101 48102 48103 48104 48105 48106 48107 48108 48109 48111 48112 48113 48115 48118 48120 48121 48122 48123 48124 48125 48126 48127 48128 48130 48134 48135 48136 48138 48141 48146 48150 48151 48152 48153 48154 48158 48164 48165 48167 48168 48170 48173 48174 48175

150 more ZIP codes map to this locality. The Detroit, MI 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 Detroit, MI, 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 Detroit, MI
Metro Allowed amount vs. Detroit, MI
Columbus, OH $356.08 -6.1%
Chicago, IL $398.63 +5.2%
Indianapolis, IN $352.37 -7.0%
Milwaukee, WI $357.88 -5.6%
Buffalo, NY $361.36 -4.7%
Pittsburgh, PA $356.49 -5.9%

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

Other codes priced in Detroit, MI Copy link

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

Other curated codes and their allowed amounts in Detroit, MI
Code Service Detroit, MI vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $413.41 -1.3%
45385 Colonoscopy With Polyp Removal $500.01 —
45380 Colonoscopy With Tissue Sampling $477.34 -0.5%
45378 Diagnostic Colonoscopy $378.46 +0.1%
43235 Screening and endoscopy $319.52 -1.0%
45384 Screening and endoscopy $539.88 +0.1%
45381 Screening and endoscopy $487.33 -0.6%
G0105 Screening and endoscopy $378.46 +0.1%
99213 Routine Follow-Up Office Visit $95.55 +0.4%
99214 Long Follow-Up Office Visit $136.48 +0.6%
66984 Cataract Surgery $467.80 +1.1%
92014 Full Eye Exam, Returning Patient $125.43 -1.4%

Common questions Copy link

Which ZIP codes does the Detroit, MI rate for G0121 cover?
The CMS ZIP-to-locality crosswalk maps 250 ZIP codes to this payment locality, and every one of them prices G0121 identically. Examples include 48005, 48007, 48009, 48012, 48015, 48017. 8 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the G0121 rate in Detroit, MI 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 0.965, malpractice 1.686 — scale each RVU component before the conversion factor is applied, which is why Detroit, MI allows more than the $378.43 baseline.
What is the facility rate for G0121 in Detroit, MI?
$173.06 in a facility, versus $379.02 in the office (non-facility) setting — a $205.96 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 G0121 in Detroit, MI?
A non-participating provider is paid $360.07 — 95% of the $379.02 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $414.08, which is 115% of the non-participating amount.
How much of the Detroit, MI G0121 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($303.22) once the annual Part B deductible is met, and the beneficiary owes 20% ($75.80). Sequestration reduces Medicare's share by about 2% ($6.06), leaving $297.16. 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 08202-01'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 64)
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 Detroit, MI 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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