Omaha, NE (Locality 05402-00)
5.6% below the national baseline ($174.35)
CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work2.60 × 1.000 + Practice exp.2.45 × 0.923 + Malpractice0.17 × 0.378 ) × Conv. factor$33.4009 = $164.52
F Work RVU
2.60
G Non‑facility PE RVU
2.45
K MP RVU
0.17
Z Conversion factor
33.4009
E Work GPCI
1.000
F PE GPCI
0.923
G MP GPCI
0.378
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 15,260 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 15,258–15,262 of PPRRVU2026_Oct_nonQPP.csv…
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 72 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 70–74 of GPCI2026.csv…
The Medicare allowed amount is $164.52 in the Office (non-facility) and Facility settings, 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.
Assumes a participating provider, no modifiers, the whole service, before sequestration.
Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method
What Medicare locality is Omaha, NE in? Copy link
CMS prices all of Nebraska as one Medicare payment locality, so this amount applies statewide, including Lincoln, Bellevue and Grand Island—not only in Omaha, NE.
Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.
ZIP codes in this payment locality (632)
The CMS ZIP-to-locality crosswalk maps 632 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 13 span more than one locality and need ZIP+4 for an exact match.
532 more ZIP codes map to this locality. The Omaha, NE locality page lists the full set.
Which ZIP codes does the Omaha, NE rate for G0438 cover?
The CMS ZIP-to-locality crosswalk maps 632 ZIP codes to this payment locality, and G0438 has the same amount in every one of them. Examples include 68001, 68002, 68003, 68004, 68005, 68007. Of these, 13 span more than one payment locality and need ZIP+4 for an exact match.
Does this G0438 rate apply everywhere in Nebraska?
Yes. CMS prices Nebraska as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Omaha, NE. That includes Lincoln, Bellevue and Grand Island. 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
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Omaha, NE 5.6% below the national baseline.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Why is the G0438 rate in Omaha, NE 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 0.923, malpractice 0.378—scale each RVU component before the conversion factor is applied, which is why the Omaha, NE amount is lower than the $174.35 baseline.
Formula and inputs Copy link
For the office (non-facility) amount, each of G0438's RVU components is multiplied by its Omaha, NE GPCI; the products are summed and multiplied by the conversion factor.
- Code
- G0438
- DOS
- Not selected; uses this release’s rates
- Locality
- NEBRASKA (NE)
- 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.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 2.60 | × 1.000 | 2.6000 |
| Practice expense · Office (non-facility) | 2.45 | × 0.923 | 2.2614 |
| Malpractice | 0.17 | × 0.378 | 0.0643 |
| Sum of adjusted RVUs | 4.9256 | ||
| × 33.4009 conversion factor = formula amount | $164.52 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
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Locality-adjusted allowed amount $164.52
After applicable fee-schedule adjustments; sequestration excluded
Citations
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G0438’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 15,260 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- G0438
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 2.60
- G Non-facility PE RVU
- 2.45
- K MP RVU
- 0.17
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 15,258–15,262 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 05402-00’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 72 in rvu26d-updated-08-26-2026.zip
- A MAC
- 05402
- C Locality number
- 00
- E Work GPCI
- 1.000
- F PE GPCI
- 0.923
- G MP GPCI
- 0.378
In the CMS file
Loading rows 70–74 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
CMS RVU26DOctober 1 – December 31, 2026revision 2
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in Omaha, NE. 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.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $164.52 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $156.29 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $179.73 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $131.62 |
| Patient coinsurance The remaining 20%. | $32.90 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $2.63 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $128.99 |
What is the non-participating amount and limiting charge for G0438 in Omaha, NE?
A non-participating provider is paid $156.29—95% of the $164.52 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $179.73, which is 115% of the non-participating amount.
How much of the Omaha, NE G0438 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($131.62) once the annual Part B deductible is met, and the beneficiary owes 20% ($32.90). Sequestration reduces Medicare's share by about 2% ($2.63), leaving $128.99. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in Omaha, NE 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—$164.52 in the office (non-facility) setting—not the $174.35 national baseline.
Opens the calculator set to Omaha, NE 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.
G0438 in nearby payment localities Copy link
Payment localities in the same region as Omaha, NE, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for G0438. Neighboring localities often differ.
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Omaha, NE · this page $164.52
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Des Moines, IA $163.97 -0.3%
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Kansas City, MO $169.23 +2.9%
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Wichita, KS $163.68 -0.5%
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Minneapolis, MN $172.73 +5.0%
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Denver, CO $179.39 +9.0%
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Chicago, IL $182.72 +11.1%
Percentages are against Omaha, NE. Every payment locality nationwide is on the HCPCS G0438 rate map.
Other codes priced in Omaha, NE Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 99497 Advance Care Planning | $82.37 | -5.1% |
| G0402 Preventive and wellness visits | $164.83 | -5.6% |
| G0439 Preventive and wellness visits | $129.59 | -5.8% |
| 99213 Routine Follow-Up Office Visit | $89.57 | -5.9% |
| 99214 Long Follow-Up Office Visit | $127.56 | -5.9% |
| 66984 Cataract Surgery | $435.59 | -5.8% |
| 92014 Full Eye Exam, Returning Patient | $120.38 | -5.4% |
| 99204 Long New Patient Office Visit | $166.02 | -6.4% |
| 99212 Brief Follow-Up Office Visit | $55.58 | -6.5% |
| 99215 Longest Follow-Up Office Visit | $180.95 | -5.9% |
| 97110 Physical Therapy Exercises | $27.80 | -4.3% |
| 99203 New Patient Office Visit | $109.72 | -6.7% |
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 05402-00'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.
Working a claim with an earlier date of service? The calculator prices G0438 in Omaha, NE 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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