Billing code 97026Medicare rate & RVUs
Compare 97026 physician payment amounts across CMS localities, including office and facility settings.
Medicare pays $6.68 for 97026 nationally in the office. Local office rates run $5.91–$8.66.
Medicare rate · 97026
Code 97026
- Work RVUs
- 0.06
- Total RVUs
- 0.20
- Global days
- XXX
National rate · 2026
$6.68
Office setting, before claim adjustments.
See every locality for 97026 →Billed by an NP, PA or therapist? →
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 97026 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$5.91 to $8.66
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $5.99 | Unavailable |
| Alaska* | $7.81 | Unavailable |
| Arizona | $6.50 | Unavailable |
| Arkansas | $5.91 | Unavailable |
| Atlanta | $6.82 | Unavailable |
| Austin | $6.90 | Unavailable |
| Bakersfield | $7.00 | Unavailable |
| Baltimore/Surr. Cntys | $7.11 | Unavailable |
| Beaumont | $6.27 | Unavailable |
| Brazoria | $6.58 | Unavailable |
| Chicago | $7.15 | Unavailable |
| Chico | $6.98 | Unavailable |
| Colorado | $6.91 | Unavailable |
| Connecticut | $7.12 | Unavailable |
| Dallas | $6.63 | Unavailable |
| Dc + Md/Va Suburbs | $7.60 | Unavailable |
| Delaware | $6.60 | Unavailable |
| Detroit | $6.76 | Unavailable |
| East St. Louis | $6.67 | Unavailable |
| El Centro | $6.98 | Unavailable |
| Fort Lauderdale | $7.01 | Unavailable |
| Fort Worth | $6.59 | Unavailable |
| Fresno | $6.98 | Unavailable |
| Galveston | $6.61 | Unavailable |
| Hanford-Corcoran | $6.98 | Unavailable |
| Hawaii, Guam | $7.13 | Unavailable |
| Houston | $6.79 | Unavailable |
| Idaho | $6.16 | Unavailable |
| Indiana | $6.19 | Unavailable |
| Iowa | $6.11 | Unavailable |
| Kansas | $6.10 | Unavailable |
| Kentucky | $6.17 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $7.44 | Unavailable |
| Madera | $6.98 | Unavailable |
| Manhattan | $7.71 | Unavailable |
| Merced | $6.98 | Unavailable |
| Metropolitan Boston | $7.57 | Unavailable |
| Metropolitan Kansas City | $6.41 | Unavailable |
| Metropolitan Philadelphia | $6.96 | Unavailable |
| Metropolitan St. Louis | $6.47 | Unavailable |
| Miami | $7.37 | Unavailable |
| Minnesota | $6.57 | Unavailable |
| Mississippi | $5.99 | Unavailable |
| Modesto | $6.98 | Unavailable |
| Montana** | $6.68 | Unavailable |
| Napa | $8.02 | Unavailable |
| Nebraska | $6.14 | Unavailable |
| Nevada** | $6.63 | Unavailable |
| New Hampshire | $6.82 | Unavailable |
| New Mexico | $6.39 | Unavailable |
| New Orleans | $6.47 | Unavailable |
| North Carolina | $6.27 | Unavailable |
| North Dakota** | $6.48 | Unavailable |
| Northern Nj | $7.52 | Unavailable |
| Nyc Suburbs/Long Island | $7.92 | Unavailable |
| Ohio | $6.31 | Unavailable |
| Oklahoma | $6.14 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $7.40 | Unavailable |
| Portland | $7.11 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $7.25 | Unavailable |
| Puerto Rico | $6.72 | Unavailable |
| Queens | $7.75 | Unavailable |
| Redding | $6.98 | Unavailable |
| Rest Of California | $6.98 | Unavailable |
| Rest Of Florida | $6.66 | Unavailable |
| Rest Of Georgia | $6.28 | Unavailable |
| Rest Of Illinois | $6.49 | Unavailable |
| Rest Of Louisiana | $6.17 | Unavailable |
| Rest Of Maine | $6.21 | Unavailable |
| Rest Of Maryland | $6.72 | Unavailable |
| Rest Of Massachusetts | $6.87 | Unavailable |
| Rest Of Michigan | $6.35 | Unavailable |
| Rest Of Missouri | $6.07 | Unavailable |
| Rest Of New Jersey | $7.19 | Unavailable |
| Rest Of New York | $6.36 | Unavailable |
| Rest Of Oregon | $6.56 | Unavailable |
| Rest Of Pennsylvania | $6.31 | Unavailable |
| Rest Of Texas | $6.43 | Unavailable |
| Rest Of Washington | $6.86 | Unavailable |
| Rhode Island | $6.83 | Unavailable |
| Riverside-San Bernardino-Ontario | $7.08 | Unavailable |
| Sacramento-Roseville-Folsom | $7.31 | Unavailable |
| Salinas | $7.28 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $7.44 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $8.47 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $8.46 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $8.66 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $8.62 | Unavailable |
| San Luis Obispo-Paso Robles | $7.16 | Unavailable |
| Santa Cruz-Watsonville | $7.50 | Unavailable |
| Santa Maria-Santa Barbara | $7.30 | Unavailable |
| Santa Rosa-Petaluma | $7.58 | Unavailable |
| Seattle (King Cnty) | $7.70 | Unavailable |
| South Carolina | $6.30 | Unavailable |
| South Dakota** | $6.46 | Unavailable |
| Southern Maine | $6.52 | Unavailable |
| Stockton | $6.98 | Unavailable |
| Suburban Chicago | $7.07 | Unavailable |
| Tennessee | $6.13 | Unavailable |
| Utah | $6.39 | Unavailable |
| Vallejo | $8.01 | Unavailable |
| Vermont | $6.47 | Unavailable |
| Virgin Islands | $6.72 | Unavailable |
| Virginia | $6.51 | Unavailable |
| Visalia | $6.98 | Unavailable |
| West Virginia | $6.26 | Unavailable |
| Wisconsin | $6.27 | Unavailable |
| Wyoming** | $6.59 | Unavailable |
| Yuba City | $6.98 | Unavailable |
97026 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$5.91
$7.82
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $7.81 | 1 |
| AL | $5.99 | 1 |
| AR | $5.91 | 1 |
| AZ | $6.50 | 1 |
| CA | $6.98–$8.66 | 29 |
| CO | $6.91 | 1 |
| CT | $7.12 | 1 |
| DC | $7.60 | 1 |
| DE | $6.60 | 1 |
| FL | $6.66–$7.37 | 3 |
| GA | $6.28–$6.82 | 2 |
| GU | $7.13 | 1 |
| HI | $7.13 | 1 |
| IA | $6.11 | 1 |
| ID | $6.16 | 1 |
| IL | $6.49–$7.15 | 4 |
| IN | $6.19 | 1 |
| KS | $6.10 | 1 |
| KY | $6.17 | 1 |
| LA | $6.17–$6.47 | 2 |
| MA | $6.87–$7.57 | 2 |
| MD | $6.72–$7.60 | 3 |
| ME | $6.21–$6.52 | 2 |
| MI | $6.35–$6.76 | 2 |
| MN | $6.57 | 1 |
| MO | $6.07–$6.47 | 3 |
| MS | $5.99 | 1 |
| MT | $6.68 | 1 |
| NC | $6.27 | 1 |
| ND | $6.48 | 1 |
| NE | $6.14 | 1 |
| NH | $6.82 | 1 |
| NJ | $7.19–$7.52 | 2 |
| NM | $6.39 | 1 |
| NV | $6.63 | 1 |
| NY | $6.36–$7.92 | 5 |
| OH | $6.31 | 1 |
| OK | $6.14 | 1 |
| OR | $6.56–$7.11 | 2 |
| PA | $6.31–$6.96 | 2 |
| PR | $6.72 | 1 |
| RI | $6.83 | 1 |
| SC | $6.30 | 1 |
| SD | $6.46 | 1 |
| TN | $6.13 | 1 |
| TX | $6.27–$6.90 | 8 |
| UT | $6.39 | 1 |
| VA | $6.51–$7.60 | 2 |
| VI | $6.72 | 1 |
| VT | $6.47 | 1 |
| WA | $6.86–$7.70 | 2 |
| WI | $6.27 | 1 |
| WV | $6.26 | 1 |
| WY | $6.59 | 1 |
How the 97026 rate is calculated
Each of 97026’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 · 97026
RVUs × geographic indexes × conversion factor
Work0.06
0.06 RVUs× 1.000 GPCI
Practice expense0.13
0.13 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.2000
Conversion factor
$33.4009
Medicare rate
$6.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97026
The CMS indicators that decide how 97026 is paid alongside other services.
CMS payment indicators · 97026
Code 97026
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97026 without CQ · national office
$6.68
97026-CQ · Allowed amount unchanged
$6.68
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
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
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