Medicare's 2026 rates in Metropolitan Philadelphia, Pennsylvania
Medicare payment locality 01, run by contractor 12502, covers these counties: Bucks, Chester, Delaware, Montgomery and Philadelphia. Its cost indices put code 99213, billed from an office, at $98.55, 3.5% above the national $95.19.
Cost indices for 2026
- Work (national = 1.000)
- 1.018
- Practice expense (national = 1.000)
- 1.041
- Malpractice (national = 1.000)
- 1.193
- ZIP codes CMS assigns to this locality
- 363
- Of those, split with another locality
- 11
30 common codes priced for Metropolitan Philadelphia
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 | $140.40 | $135.61 | $87.20 |
| 99213 | Visit or care management | $98.55 | $95.19 | $59.26 |
| 97110 | Physical therapy or rehabilitation | $29.96 | $29.06 | none |
| 97530 | Physical therapy or rehabilitation | $36.22 | $35.07 | none |
| 97112 | Physical therapy or rehabilitation | $33.74 | $32.73 | none |
| 97140 | Physical therapy or rehabilitation | $28.58 | $27.72 | none |
| 17003 | Skin and soft tissue procedure | $6.58 | $6.35 | $1.71 |
| 88305 | Lab test or pathology | $72.56 | $70.14 | none |
| 93010 | Heart test or procedure | $8.61 | $8.35 | $8.61 |
| 99309 | Visit or care management | $118.50 | $114.57 | $101.81 |
| 99215 | Visit or care management | $199.19 | $192.39 | $129.65 |
| 98941 | Manipulation | $39.51 | $38.41 | $28.73 |
| 71045 | Imaging | $26.39 | $25.38 | none |
| 99204 | Visit or care management | $183.85 | $177.36 | $120.92 |
| 99308 | Visit or care management | $81.47 | $78.83 | $69.99 |
| 93000 | Heart test or procedure | $15.97 | $15.36 | none |
| 92014 | Eye exam or test | $131.59 | $127.26 | $63.79 |
| 99203 | Visit or care management | $121.97 | $117.57 | $73.99 |
| 95004 | Allergy testing or treatment | $3.87 | $3.67 | none |
| 92134 | Eye exam or test | $33.94 | $32.73 | none |
| 96372 | Infusion, injection or chemotherapy | $15.91 | $15.36 | none |
| 99490 | Visit or care management | $68.43 | $66.13 | $45.14 |
| 90837 | Mental health service | $171.05 | $167.00 | $138.02 |
| 93306 | Heart test or procedure | $204.11 | $196.73 | none |
| 99212 | Visit or care management | $61.66 | $59.45 | $32.10 |
| 71046 | Imaging | $34.36 | $33.07 | none |
| 17000 | Skin and soft tissue procedure | $69.04 | $66.47 | $49.57 |
| 77067 | Imaging | $131.12 | $126.26 | none |
| 95165 | Allergy testing or treatment | $18.09 | $17.37 | $2.79 |
| 77063 | Imaging | $52.90 | $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.