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Manhattan, NY: Medicare locality 13202-01 (2026)

Manhattan is one of 5 Medicare payment localities in New York. This page gives its 2026 geographic practice cost indices, what common codes pay there against the national amount, the counties and ZIP codes CMS assigns to it, and how it compares with the rest of the state.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: PFS GPCIs, anesthesia conversion factors and localities: CY2026 Addendum E (RVU26D) (effective January 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); ZIP code to carrier locality file: ZIP5 October 2026 (file updated August 13, 2026) (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026). Next CMS release: CY2027 PFS final rule (November 2026), effective January 1, 2027 for the PFS GPCIs, anesthesia conversion factors and localities; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; January 1, 2027 (quarterly update) for the ZIP code to carrier locality file and DMEPOS fee schedule.

TL;DR

Manhattan is Medicare payment locality 01 of contractor 13202 in New York, one of 5 localities in the state. Its 2026 indices are 1.064 for work, 1.162 for practice expense and 1.586 for malpractice, a geographic adjustment factor of 1.130 (+13.0% against the national 1.000, rank 10 of 109). In an office, 99213 pays $107.63 here against $95.19 nationally, G2211 $19.39 against $17.37 and G0439 $155.46 against $137.61. The locality takes in New York, 165 ZIP codes in the October 2026 file.

Locality 13202-01 at a glance

Contractor and locality
13202-01
Wellpoint Federal
Geographic adjustment factor
1.130
+13.0% vs national, rank 10 of 109
Anesthesia conversion factor
$22.81
QP $22.92; national $20.50
ZIP codes
165
0 rural, 0 super rural
DMEPOS rural ZIP codes
0
on the quarter 4 2026 list

2026 GPCIs for Manhattan

2026 geographic practice cost indices for Medicare locality 13202-01
ComponentGPCIvs national 1.000
Work (physician time and effort)1.064+6.4%
Practice expense (staff, rent, equipment, supplies)1.162+16.2%
Malpractice (professional liability insurance)1.586+58.6%
Geographic adjustment factor (weighted)1.130+13.0%

A fee schedule amount here is [(work RVU x 1.064) + (practice expense RVU x 1.162) + (malpractice RVU x 1.586)] x the conversion factor. The practice expense index weighs most on office services, whose non-facility practice expense RVU carries the practice's overhead, while the work index weighs most on surgery and other physician-intensive services. The work index is above the 1.0 floor, so the floor does not affect this locality.

Example payments in Manhattan

Amounts at the non-QP conversion factor for one unit of the global service, computed from the RVU26D store with this locality's indices; the national column uses indices of 1.000. CPT numbers are shown without descriptors. Open a code to see every modifier row, both conversion factors and the payment indicators.

2026 Medicare physician fee schedule amounts in Manhattan and nationally for example codes
CodeOffice (non-facility)NationalFacilityvs national
99213CPT number$107.63$95.19$63.78+13.1%
99214CPT number$153.27$135.61$93.89+13.0%
G2211$19.39$17.37$15.89+11.6%
G0439$155.46$137.61$155.46+13.0%
G0402$196.88$174.69$126.63+12.7%
20610CPT number$79.27$68.81$45.51+15.2%

Counties and ZIP codes in locality 13202-01

The CMS locality file defines Manhattan as New York. The October 2026 ZIP code file assigns 165 ZIP codes to it; 0 are flagged rural and 0 super rural for physician fee schedule purposes, and none is split by ZIP+4.

Three-digit ZIP prefixes in Medicare locality 13202-01
ZIP prefixZIP codes
100xx64
101xx69
102xx32
Every ZIP code in locality 13202-01 (29 ranges)

10001-10041, 10043-10048, 10055, 10060, 10065, 10069, 10072, 10075, 10079-10082, 10087, 10090, 10094-10096, 10098-10099, 10101-10126, 10128-10133, 10138, 10149-10179, 10184-10185, 10196-10197, 10199-10200, 10203, 10211-10213, 10242, 10249, 10256-10261, 10265, 10268-10282, 10285-10286, 10292

Other localities in New York

Other Medicare payment localities in New York, 2026
LocalityGAFvs ManhattanZIP codes
NYC Suburbs/Long Island1.154+2.1%440
Poughkeepsie/N NYC Suburbs1.075-4.9%324
Queens1.133+0.3%84
Rest of New York0.965-14.6%1,234

All 5 localities with their counties are compared on the New York Medicare fee schedule page.

Localities with a similar adjustment

Ranked by geographic adjustment factor, the localities on either side of Manhattan are Queens, NY (1.133) and Seattle (King County), WA (1.119). Localities with the same GAF can still pay a given code differently when their work and practice expense indices are mixed in different proportions.

DMEPOS amounts in New York

Durable medical equipment, prosthetics, orthotics and supplies are not priced by locality. The October 2026 DMEPOS fee schedule (DME26-D) sets one non-rural and one rural amount per code for the whole state, and the rural amount applies only in the ZIP codes on the quarterly DMEPOS rural list. The table shows the New York amounts for common items next to the lowest and highest non-rural amount among the contiguous states; HCPCS Level II descriptors are CMS's.

DMEPOS fee schedule amounts in New York, October 2026
CodeItemNon-ruralRuralContiguous states
E0601-RRContinuous positive airway pressure (cpap) devicecapped rental, monthly rental$50.04$97.02$50.04 to $52.65
E0260-RRHospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattresscapped rental, monthly rental$74.43$128.14$72.80 to $78.16
K0001-RRStandard wheelchaircapped rental, monthly rental$26.42$52.43$25.23 to $31.07
E0143-NUWalker, folding, wheeled, adjustable or fixed heightinexpensive or routinely purchased, purchased new$57.03$106.25$55.55 to $60.89
E0114-NUCrutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgripsinexpensive or routinely purchased, purchased new$62.68—$57.17 to $67.26
A4253-NUBlood glucose test or reagent strips for home blood glucose monitor, per 50 stripsinexpensive or routinely purchased, purchased new$8.32—$8.32 in every state
L1833Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelfprosthetics and orthotics$503.87$743.90$455.16 to $556.31
E0784-RRExternal ambulatory infusion pump, insulincapped rental, monthly rental$557.75$576.42$557.75 in every state
Former competitive bidding areas use CMS's separate former CBA fee schedule for the items it lists; see the DMEPOS fee schedule page.

Contractor, coverage and other payment systems

Part B claims in this locality are processed by Wellpoint Federal, whose local coverage determinations decide which services are covered and with which diagnoses. The locality adjusts only physician fee schedule payments. Clinical laboratory tests are paid at one national amount from the Clinical Laboratory Fee Schedule, hospital outpatient services through APCs adjusted by each hospital's wage index rather than by these indices, and Part B drugs at the national ASP payment limits. QuickIntell's New York page covers the state's payers and revenue-cycle requirements.

Where QuickIntell fits for New York practices

Contract management in QuickRCM keeps payer contracts and fee schedules with their effective dates and compares expected reimbursement against allowed amounts, so a claim priced at the wrong locality, or with last year's indices, is reviewed before a dispute is opened.

See contract management in QuickRCMSee QuickRCMBook a meeting

Frequently asked questions

What are the 2026 GPCIs for Manhattan?

Work 1.064, practice expense 1.162 and malpractice 1.586 for locality 13202-01, a geographic adjustment factor of 1.130.

How much does Medicare pay for 99213 in Manhattan?

$107.63 in an office and $63.78 in a facility setting at the 2026 non-QP conversion factor, against $95.19 and $57.45 nationally. Medicare pays 80% of the allowed amount after the Part B deductible.

Which ZIP codes are in Medicare locality 13202-01?

165 ZIP codes in the October 2026 CMS ZIP file, in the prefixes 100, 101 and 102. 0 are rural and 0 super rural in that file.

Who processes Part B claims for Manhattan?

Wellpoint Federal, under contractor number 13202. The same contractor writes the local coverage determinations that apply to the locality.

More on Medicare localities

Every locality and the ZIP code finder are on the Medicare payment localities hub; the national GPCI table with anesthesia conversion factors is on the physician fee schedule page, and the fee schedules hub maps which CMS schedule pays which claim.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from CMS physician fee schedule and DMEPOS public use files. Amounts are Medicare fee schedule amounts before the deductible, coinsurance, sequestration and claim-level reductions; Medicare Advantage and commercial contracts set their own rates. CPT codes appear as bare numbers; CPT descriptors are copyright AMA. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.