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CMS RVU26D · Effective 2026-10-01
42405 Medicare reimbursement rates
Compare 42405 physician payment amounts across CMS localities, including office and facility settings.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 42405?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$273.74–$392.56
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $118.82 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 42405 pays more and less
109 payment localities
$273.74 to $392.56
See how rates vary across the country
42405 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$273.74
$366.37
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $366.37 | 1 |
| AL | $277.45 | 1 |
| AR | $273.74 | 1 |
| AZ | $299.08 | 1 |
| CA | $319.22–$392.56 | 29 |
| CO | $316.59 | 1 |
| CT | $326.43 | 1 |
| DC | $347.09 | 1 |
| DE | $303.75 | 1 |
| FL | $306.64–$337.94 | 3 |
| GA | $290.17–$313.29 | 2 |
| GU | $325.52 | 1 |
| HI | $325.52 | 1 |
| IA | $282.16 | 1 |
| ID | $284.24 | 1 |
| IL | $299.71–$328.53 | 4 |
| IN | $285.72 | 1 |
| KS | $281.79 | 1 |
| KY | $285.37 | 1 |
| LA | $285.30–$298.26 | 2 |
| MA | $315.26–$345.17 | 2 |
| MD | $308.98–$347.09 | 3 |
| ME | $286.53–$299.64 | 2 |
| MI | $293.04–$311.10 | 2 |
| MN | $301.44 | 1 |
| MO | $281.34–$298.22 | 3 |
| MS | $277.55 | 1 |
| MT | $306.92 | 1 |
| NC | $289.17 | 1 |
| ND | $297.83 | 1 |
| NE | $283.33 | 1 |
| NH | $312.52 | 1 |
| NJ | $329.61–$344.09 | 2 |
| NM | $294.88 | 1 |
| NV | $304.57 | 1 |
| NY | $293.26–$361.62 | 5 |
| OH | $291.18 | 1 |
| OK | $283.98 | 1 |
| OR | $301.66–$325.04 | 2 |
| PA | $291.13–$319.37 | 2 |
| PR | $308.73 | 1 |
| RI | $313.39 | 1 |
| SC | $290.76 | 1 |
| SD | $296.75 | 1 |
| TN | $283.21 | 1 |
| TX | $289.42–$316.02 | 8 |
| UT | $294.42 | 1 |
| VA | $299.33–$347.09 | 2 |
| VI | $308.73 | 1 |
| VT | $297.54 | 1 |
| WA | $314.38–$351.06 | 2 |
| WI | $288.65 | 1 |
| WV | $289.64 | 1 |
| WY | $302.96 | 1 |
Compare 42405 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $277.45 | Facility $185.68 |
| Alaska* | Office $366.37 | Facility $254.68 |
| Arizona | Office $299.08 | Facility $197.45 |
| Arkansas | Office $273.74 | Facility $183.65 |
| Atlanta | Office $313.29 | Facility $206.74 |
| Austin | Office $316.02 | Facility $205.06 |
| Bakersfield | Office $320.56 | Facility $205.61 |
| Baltimore/Surr. Cntys | Office $325.68 | Facility $213.14 |
| Beaumont | Office $289.42 | Facility $193.98 |
| Brazoria | Office $302.80 | Facility $198.87 |
| Chicago | Office $328.53 | Facility $223.12 |
| Chico | Office $319.22 | Facility $204.27 |
| Colorado | Office $316.59 | Facility $205.00 |
| Connecticut | Office $326.43 | Facility $213.47 |
| Dallas | Office $305.02 | Facility $200.56 |
| Dc + Md/Va Suburbs | Office $347.09 | Facility $223.54 |
| Delaware | Office $303.75 | Facility $200.13 |
| Detroit | Office $311.10 | Facility $209.89 |
| East St. Louis | Office $307.92 | Facility $211.43 |
| El Centro | Office $319.29 | Facility $204.35 |
| Fort Lauderdale | Office $321.74 | Facility $215.50 |
| Fort Worth | Office $303.39 | Facility $199.98 |
| Fresno | Office $319.22 | Facility $204.27 |
| Galveston | Office $303.90 | Facility $199.76 |
| Hanford-Corcoran | Office $319.22 | Facility $204.27 |
| Hawaii, Guam | Office $325.52 | Facility $206.27 |
| Houston | Office $312.32 | Facility $208.18 |
| Idaho | Office $284.24 | Facility $187.75 |
| Indiana | Office $285.72 | Facility $188.50 |
| Iowa | Office $282.16 | Facility $186.20 |
| Kansas | Office $281.79 | Facility $186.98 |
| Kentucky | Office $285.37 | Facility $192.13 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $339.69 | Facility $215.62 |
| Madera | Office $319.22 | Facility $204.27 |
| Manhattan | Office $352.52 | Facility $230.66 |
| Merced | Office $319.22 | Facility $204.27 |
| Metropolitan Boston | Office $345.17 | Facility $219.95 |
| Metropolitan Kansas City | Office $295.46 | Facility $196.97 |
| Metropolitan Philadelphia | Office $319.37 | Facility $210.19 |
| Metropolitan St. Louis | Office $298.22 | Facility $198.37 |
| Miami | Office $337.94 | Facility $228.76 |
| Minnesota | Office $301.44 | Facility $193.52 |
| Mississippi | Office $277.55 | Facility $187.25 |
| Modesto | Office $319.22 | Facility $204.27 |
| Montana** | Office $306.92 | Facility $202.04 |
| Napa | Office $364.35 | Facility $226.12 |
| Nebraska | Office $283.33 | Facility $186.53 |
| Nevada** | Office $304.57 | Facility $199.59 |
| New Hampshire | Office $312.52 | Facility $203.35 |
| New Mexico | Office $294.88 | Facility $198.70 |
| New Orleans | Office $298.26 | Facility $199.57 |
| North Carolina | Office $289.17 | Facility $191.31 |
| North Dakota** | Office $297.83 | Facility $192.95 |
| Northern Nj | Office $344.09 | Facility $222.43 |
| Nyc Suburbs/Long Island | Office $361.62 | Facility $236.92 |
| Ohio | Office $291.18 | Facility $195.43 |
| Oklahoma | Office $283.98 | Facility $190.32 |
| Oxnard-Thousand Oaks-Ventura | Office $337.46 | Facility $213.50 |
| Portland | Office $325.04 | Facility $208.52 |
| Poughkpsie/N Nyc Suburbs | Office $332.44 | Facility $217.60 |
| Puerto Rico | Office $308.73 | Facility $202.70 |
| Queens | Office $353.97 | Facility $230.00 |
| Redding | Office $319.22 | Facility $204.27 |
| Rest Of California | Office $319.22 | Facility $204.27 |
| Rest Of Florida | Office $306.64 | Facility $206.38 |
| Rest Of Georgia | Office $290.17 | Facility $196.62 |
| Rest Of Illinois | Office $299.71 | Facility $203.95 |
| Rest Of Louisiana | Office $285.30 | Facility $192.48 |
| Rest Of Maine | Office $286.53 | Facility $190.04 |
| Rest Of Maryland | Office $308.98 | Facility $202.84 |
| Rest Of Massachusetts | Office $315.26 | Facility $204.82 |
| Rest Of Michigan | Office $293.04 | Facility $197.29 |
| Rest Of Missouri | Office $281.34 | Facility $190.94 |
| Rest Of New Jersey | Office $329.61 | Facility $215.08 |
| Rest Of New York | Office $293.26 | Facility $193.62 |
| Rest Of Oregon | Office $301.66 | Facility $197.20 |
| Rest Of Pennsylvania | Office $291.13 | Facility $194.85 |
| Rest Of Texas | Office $296.15 | Facility $196.62 |
| Rest Of Washington | Office $314.38 | Facility $203.94 |
| Rhode Island | Office $313.39 | Facility $205.05 |
| Riverside-San Bernardino-Ontario | Office $324.20 | Facility $209.25 |
| Sacramento-Roseville-Folsom | Office $333.53 | Facility $211.55 |
| Salinas | Office $332.25 | Facility $210.70 |
| San Diego-Chula Vista-Carlsbad | Office $338.99 | Facility $213.56 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $383.89 | Facility $236.02 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $383.37 | Facility $235.49 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $392.56 | Facility $241.32 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $390.42 | Facility $239.19 |
| San Luis Obispo-Paso Robles | Office $327.07 | Facility $207.61 |
| Santa Cruz-Watsonville | Office $341.39 | Facility $213.97 |
| Santa Maria-Santa Barbara | Office $333.20 | Facility $210.91 |
| Santa Rosa-Petaluma | Office $344.75 | Facility $215.96 |
| Seattle (King Cnty) | Office $351.06 | Facility $222.37 |
| South Carolina | Office $290.76 | Facility $193.86 |
| South Dakota** | Office $296.75 | Facility $191.87 |
| Southern Maine | Office $299.64 | Facility $195.71 |
| Stockton | Office $319.22 | Facility $204.27 |
| Suburban Chicago | Office $324.51 | Facility $216.80 |
| Tennessee | Office $283.21 | Facility $187.88 |
| Utah | Office $294.42 | Facility $195.84 |
| Vallejo | Office $363.60 | Facility $225.37 |
| Vermont | Office $297.54 | Facility $193.71 |
| Virgin Islands | Office $308.73 | Facility $202.70 |
| Virginia | Office $299.33 | Facility $196.24 |
| Visalia | Office $319.22 | Facility $204.27 |
| West Virginia | Office $289.64 | Facility $198.50 |
| Wisconsin | Office $288.65 | Facility $188.17 |
| Wyoming** | Office $302.96 | Facility $198.08 |
| Yuba City | Office $319.22 | Facility $204.27 |
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Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.