CPT code 99310: Nursing facility visit, subsequent visit, high MDM2026 Medicare rate & RVUs in New York, New York
CPT 99310: $183.60–$187.20 office ($156.60–$159.79 facility) across 3 localities in New York, NY in 2026 Medicare. Compare each area.
Medicare pays $183.60–$187.20 for 99310 in the office in New York, New York, from Manhattan, NY to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 99310 pays more and less in New York, New York
New York, New York maps to 3 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
3 payment localities
$183.60 to $187.20
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $183.60 | $156.82 |
| NYC suburbs and Long Island, NY | $187.20 | $159.79 |
| Queens, NY | $183.84 | $156.60 |
How payment areas work in New York
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- NYC suburbs / Long Island · Bronx County, Kings County, Richmond County
- Manhattan · New York County
- Queens · Queens County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 99310 rate is calculated
Each of 99310’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99310
RVUs × geographic indexes × conversion factor
Work2.80
2.80 RVUs× 1.000 GPCI
Practice expense1.88
1.88 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
4.8900
Conversion factor
$33.4009
Medicare rate
$163.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99310
99310 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99310
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$163.33
- Non-facility (office)
- $163.33
- Facility
- $140.28
Higher because the practice carries its own overhead.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 99310 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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