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Medicare Physician Fee Schedule · Q3 2026 release

HCPCS G0402 in Buffalo, NY 13282-99

Initial preventive exam in ZIPs including 14202, 14604, and 12207

G0402 2026 C · Buffalo, NY flag13282-99 A Active
Allowed amount
$168.89
in a doctor’s own office or clinic

96.7% of the $174.69 national baseline

Medicare payment
$135.11
Patient / secondary
$33.78
Expected total to provider
$168.89

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 G0402 in Buffalo, NY? Copy link

The Medicare allowed amount is $168.89 in the office (non-facility) setting and $111.46 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 3.3% below the national baseline, and the facility amount is 2.4% below 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 Buffalo, NY in? Copy link

CMS calls this locality Rest of New York — the remainder of the state after the metros CMS carved out separately. The same amount applies across all of it, including Rochester, Albany and Syracuse.

Why Buffalo, NY differs from the national amount Copy link

Buffalo, NY (this locality)
$168.89
National PFS baseline (GPCI 1.000)
$174.69

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 Buffalo, NY at 3.3% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.950
Malpractice GPCI
0.703
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for G0402 in Buffalo, NY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Buffalo, NY allowed amount for G0402
Component RVU × GPCI = Adjusted RVU
Work 2.60 1.000 2.6000
Practice expense 2.46 0.950 2.3370
Malpractice 0.17 0.703 0.1195
Sum of adjusted RVUs 5.0565
× $33.4009 2026 conversion factor $168.89

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Buffalo, NY allows $111.46 for G0402, versus $168.89 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 Buffalo, NY. 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 G0402 in Buffalo, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $168.89
Non-participating allowed amount 95% of the participating amount. $160.45
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $184.52
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $135.11
Beneficiary coinsurance The remaining 20%. $33.78
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $2.70
Medicare pays after sequestration Program payment net of the sequestration reduction. $132.41

Contracted rate: % of Medicare in Buffalo, NY 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 — $168.89 in the office (non-facility) setting — not the $174.69 national baseline.

Opens the calculator already set to Buffalo, NY 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 Buffalo, NY rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 1,234 ZIP codes to this payment locality. G0402 prices identically in every one of them. 1 of them span more than one locality and need ZIP+4 for an exact match.

12007 12008 12009 12010 12016 12018 12019 12020 12022 12023 12024 12025 12027 12028 12031 12032 12033 12035 12036 12040 12041 12043 12045 12046 12047 12052 12053 12054 12055 12056 12057 12059 12061 12062 12063 12064 12065 12066 12067 12068 12069 12070 12071 12072 12073 12074 12076 12077 12078 12082 12084 12085 12086 12089 12090 12092 12093 12094 12095 12107 12108 12110 12111 12116 12117 12118 12120 12121 12122 12123 12128 12131 12133 12134 12137 12138 12139 12140 12141 12143 12144 12147 12148 12149 12150 12151 12153 12154 12155 12156 12157 12158 12159 12160 12161 12162 12164 12166 12168 12169

1,134 more ZIP codes map to this locality. The Buffalo, NY locality page lists the full set.

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

G0402 in nearby payment localities Copy link

Payment localities in the same region as Buffalo, NY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for G0402. Proximity doesn't imply similar pricing — neighbouring localities often differ.

G0402 allowed amount in payment localities near Buffalo, NY
Metro Allowed amount vs. Buffalo, NY
Pittsburgh, PA $167.64 -0.7%
Columbus, OH $167.58 -0.8%
Detroit, MI $175.71 +4.0%
New York City, NY $196.88 +16.6%
Philadelphia, PA $180.71 +7.0%
Boston, MA $193.56 +14.6%

Every payment locality nationwide is on the HCPCS G0402 rate map.

Other codes priced in Buffalo, NY Copy link

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

Other curated codes and their allowed amounts in Buffalo, NY
Code Service Buffalo, NY vs. national
99497 Advance Care Planning $84.26 -3.0%
G0438 Preventive and wellness visits $168.57 -3.3%
G0439 Preventive and wellness visits $132.87 -3.4%
99213 Routine Follow-Up Office Visit $91.86 -3.5%
99214 Long Follow-Up Office Visit $130.88 -3.5%
66984 Cataract Surgery $446.99 -3.4%
92014 Full Eye Exam, Returning Patient $122.94 -3.4%
99204 Long New Patient Office Visit $170.85 -3.7%
99212 Brief Follow-Up Office Visit $57.15 -3.9%
99215 Longest Follow-Up Office Visit $185.71 -3.5%
97110 Physical Therapy Exercises $28.27 -2.7%
99203 New Patient Office Visit $113.04 -3.9%

Common questions Copy link

Which ZIP codes does the Buffalo, NY rate for G0402 cover?
The CMS ZIP-to-locality crosswalk maps 1,234 ZIP codes to this payment locality, and every one of them prices G0402 identically. Examples include 12007, 12008, 12009, 12010, 12016, 12018. 1 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the G0402 rate in Buffalo, NY 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 0.950, malpractice 0.703 — scale each RVU component before the conversion factor is applied, which is why Buffalo, NY allows less than the $174.69 baseline.
Which cities does the Buffalo, NY rate for G0402 cover?
CMS calls this locality "REST OF NEW YORK" — it is the remainder of the state after the metros CMS carved out into their own localities. The same allowed amount applies across all of it, including Rochester, Albany and Syracuse. Buffalo, NY is the label used here because it is the largest metro in the locality, not because it is priced separately.
What is the facility rate for G0402 in Buffalo, NY?
$111.46 in a facility, versus $168.89 in the office (non-facility) setting — a $57.43 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 G0402 in Buffalo, NY?
A non-participating provider is paid $160.45 — 95% of the $168.89 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $184.52, which is 115% of the non-participating amount.
How much of the Buffalo, NY G0402 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($135.11) once the annual Part B deductible is met, and the beneficiary owes 20% ($33.78). Sequestration reduces Medicare's share by about 2% ($2.70), leaving $132.41. 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 13282-99'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 15,162)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 82)
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 G0402 in Buffalo, NY 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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