Medicare's 2026 rates in Northern NJ, New Jersey
Medicare payment locality 01, run by contractor 12402, covers these counties: Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union and Warren. Its cost indices put code 99213, billed from an office, at $105.93, 11.3% above the national $95.19.
Cost indices for 2026
- Work (national = 1.000)
- 1.063
- Practice expense (national = 1.000)
- 1.160
- Malpractice (national = 1.000)
- 1.068
- ZIP codes CMS assigns to this locality
- 429
- Of those, split with another locality
- 4
30 common codes priced for Northern NJ
Physician fee schedule amounts for 2026. Office is what Medicare allows when a doctor's office or clinic bills the code; facility is what it allows a doctor for the same work in a hospital or surgery center.
| Code | Category | Office here | Office national | Facility here |
|---|---|---|---|---|
| 99214 | Visit or care management | $150.65 | $135.61 | $91.37 |
| 99213 | Visit or care management | $105.93 | $95.19 | $62.15 |
| 97110 | Physical therapy or rehabilitation | $32.22 | $29.06 | none |
| 97530 | Physical therapy or rehabilitation | $39.23 | $35.07 | none |
| 97112 | Physical therapy or rehabilitation | $36.32 | $32.73 | none |
| 97140 | Physical therapy or rehabilitation | $30.73 | $27.72 | none |
| 17003 | Skin and soft tissue procedure | $7.23 | $6.35 | $1.81 |
| 88305 | Lab test or pathology | $78.94 | $70.14 | none |
| 93010 | Heart test or procedure | $9.10 | $8.35 | $9.10 |
| 99309 | Visit or care management | $126.24 | $114.57 | $107.65 |
| 99215 | Visit or care management | $213.45 | $192.39 | $135.96 |
| 98941 | Manipulation | $42.29 | $38.41 | $30.28 |
| 71045 | Imaging | $28.80 | $25.38 | none |
| 99204 | Visit or care management | $196.57 | $177.36 | $126.45 |
| 99308 | Visit or care management | $86.98 | $78.83 | $74.19 |
| 93000 | Heart test or procedure | $17.21 | $15.36 | none |
| 92014 | Eye exam or test | $142.90 | $127.26 | $67.34 |
| 99203 | Visit or care management | $130.71 | $117.57 | $77.24 |
| 95004 | Allergy testing or treatment | $4.20 | $3.67 | none |
| 92134 | Eye exam or test | $36.90 | $32.73 | none |
| 96372 | Infusion, injection or chemotherapy | $17.24 | $15.36 | none |
| 99490 | Visit or care management | $73.26 | $66.13 | $47.30 |
| 90837 | Mental health service | $181.42 | $167.00 | $144.61 |
| 93306 | Heart test or procedure | $223.36 | $196.73 | none |
| 99212 | Visit or care management | $66.51 | $59.45 | $33.58 |
| 71046 | Imaging | $37.62 | $33.07 | none |
| 17000 | Skin and soft tissue procedure | $75.01 | $66.47 | $53.31 |
| 77067 | Imaging | $143.91 | $126.26 | none |
| 95165 | Allergy testing or treatment | $19.92 | $17.37 | $2.87 |
| 77063 | Imaging | $57.28 | $51.10 | none |
Hospital outpatient rates and lab fee schedule amounts are national, so they are the same here as everywhere; each code page lists them.