Most commercial contracts are written as a percentage of Medicare’s published rates. For 2026, those rates went up for office work and down for work done in hospitals and surgery centers. We took every Medicare service New York and New Jersey practitioners billed in 2024 and priced it at both years’ rates.
This is the dollar amount each code’s relative value is multiplied by. It includes a 2.5% increase that Congress passed for 2026 only.
CMS reduced the physician work value of many services that are not billed by time. Most of these are procedures, not visits.
CMS now recognizes half of a physician’s indirect practice costs when the service happens in a facility, and redistributes the rest to office services.
Each row re-prices that specialty’s own 2024 New York Medicare volume at Manhattan’s 2025 and 2026 rates, split by where the work happened. The share under each name is how much of that specialty’s Medicare dollars come from facility work.
Bars share one scale: a full track is 14%. Physical therapy in private practice has no facility work, so its blended change is its office change.
The change columns keep each specialty’s 2024 service mix fixed and only change the rates. The dollar columns are actual 2024 Medicare allowed amounts from CMS.
| Specialty | 2024 Medicare $ NY | 2024 Medicare $ NJ | Change, Manhattan | Change, rest of NY | Change, northern NJ | Share of $ priced |
|---|---|---|---|---|---|---|
| Internal Medicine | $743M | $428M | +2.3% | +2.7% | +1.6% | 92% |
| Physical therapy (private practice) | $455M | $317M | +1.0% | +1.5% | +0.8% | 100% |
| Cardiology | $470M | $276M | +4.1% | +4.5% | +3.7% | 58% |
| Ophthalmology | $348M | $170M | +1.1% | +1.5% | +1.1% | 79% |
| Family Practice | $246M | $142M | +5.1% | +5.5% | +6.2% | 92% |
| Dermatology | $209M | $106M | +2.7% | +3.2% | +2.5% | 94% |
| Podiatry | $187M | $111M | +4.2% | +4.5% | +3.9% | 98% |
| Orthopedic Surgery | $156M | $87M | +1.3% | +1.8% | +1.9% | 91% |
| Urology | $126M | $70M | +4.9% | +5.2% | +4.8% | 78% |
| Neurology | $130M | $54M | +3.0% | +3.4% | +2.6% | 73% |
| Gastroenterology | $117M | $62M | +3.3% | +3.8% | −0.3% | 96% |
| Hematology-Oncology | $98M | $60M | +5.0% | +5.3% | +5.2% | 85% |
| Medicare pricing area | Office work | Facility work | Blended |
|---|---|---|---|
| Manhattan | +5.8% | −6.6% | +2.0% |
| NYC suburbs / Long Island | +5.5% | −6.6% | +1.8% |
| Poughkeepsie / north NYC suburbs | +5.5% | −6.7% | +1.8% |
| Queens | +5.6% | −6.8% | +1.8% |
| Rest of New York | +6.2% | −6.0% | +2.5% |
| Northern New Jersey | +5.7% | −6.7% | +1.7% |
| Rest of New Jersey | +5.4% | −6.6% | +1.5% |
Each specialty’s five largest codes by 2024 Medicare dollars, with the published rate in three pricing areas. Codes are shown by number only; CPT descriptions are licensed by the AMA.
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $224M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $113M |
| 99233 | facility | $127.61 | $118.89 | −6.8% | $115.66 | $104.06 | $99M |
| 99232 | facility | $85.88 | $78.39 | −8.7% | $76.23 | $68.62 | $91M |
| G0439 | office | $143.26 | $155.46 | +8.5% | $153.01 | $132.87 | $63M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 97110 | office | $32.26 | $32.43 | +0.5% | $32.22 | $28.27 | $243M |
| 97530 | office | $39.08 | $39.45 | +0.9% | $39.23 | $33.97 | $177M |
| 97112 | office | $35.86 | $36.54 | +1.9% | $36.32 | $31.85 | $153M |
| 97140 | office | $30.44 | $30.95 | +1.7% | $30.73 | $26.97 | $97M |
| 97116 | office | $32.26 | $32.43 | +0.5% | $32.22 | $28.27 | $28M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $174M |
| 99232 | facility | $85.88 | $78.39 | −8.7% | $76.23 | $68.62 | $27M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $25M |
| 99215 | office | $198.98 | $217.37 | +9.2% | $213.45 | $185.71 | $24M |
| 99233 | facility | $127.61 | $118.89 | −6.8% | $115.66 | $104.06 | $22M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 92014 | office | $137.05 | $143.79 | +4.9% | $142.90 | $122.94 | $111M |
| 66984 | facility | $593.06 | $521.72 | −12.0% | $511.73 | $446.99 | $54M |
| 92012 | office | $97.04 | $102.59 | +5.7% | $101.93 | $87.28 | $44M |
| 67028 | office | $124.30 | $129.71 | +4.4% | $127.63 | $109.95 | $38M |
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $30M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $120M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $57M |
| G0439 | office | $143.26 | $155.46 | +8.5% | $153.01 | $132.87 | $33M |
| 99309 | facility | $117.23 | $110.19 | −6.0% | $107.65 | $95.66 | $10M |
| 99308 | facility | $80.75 | $75.67 | −6.3% | $74.19 | $65.92 | $10M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $60M |
| 17311 | office | $760.80 | $763.62 | +0.4% | $752.32 | $638.90 | $29M |
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $27M |
| 11102 | office | $110.43 | $109.76 | −0.6% | $108.55 | $91.32 | $23M |
| 17000 | office | $76.12 | $76.15 | 0.0% | $75.01 | $63.63 | $18M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $76M |
| 11721 | office | $49.79 | $51.37 | +3.2% | $50.44 | $43.31 | $41M |
| 11056 | office | $91.03 | $93.28 | +2.5% | $92.44 | $77.59 | $30M |
| 99203 | office | $124.41 | $133.65 | +7.4% | $130.71 | $113.04 | $15M |
| 99212 | office | $62.62 | $67.64 | +8.0% | $66.51 | $57.15 | $13M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $38M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $36M |
| 27447 | facility | $1,465.45 | $1,341.54 | −8.5% | $1,270.57 | $1,100.13 | $28M |
| 27130 | facility | $1,467.49 | $1,345.07 | −8.3% | $1,273.58 | $1,102.42 | $18M |
| 99204 | office | $185.78 | $200.98 | +8.2% | $196.57 | $170.85 | $18M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $49M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $31M |
| 52000 | office | $246.40 | $248.68 | +0.9% | $244.85 | $205.82 | $14M |
| 99204 | office | $185.78 | $200.98 | +8.2% | $196.57 | $170.85 | $11M |
| G2211 | office | $17.34 | $19.39 | +11.8% | $19.02 | $16.89 | $3M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $33M |
| 99215 | office | $198.98 | $217.37 | +9.2% | $213.45 | $185.71 | $16M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $10M |
| 99204 | office | $185.78 | $200.98 | +8.2% | $196.57 | $170.85 | $9M |
| 99232 | facility | $85.88 | $78.39 | −8.7% | $76.23 | $68.62 | $7M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $34M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $15M |
| 45385 | facility | $277.19 | $252.27 | −9.0% | $243.19 | $215.52 | $14M |
| 99204 | office | $185.78 | $200.98 | +8.2% | $196.57 | $170.85 | $13M |
| 99232 | facility | $85.88 | $78.39 | −8.7% | $76.23 | $68.62 | $11M |
| Code | Setting | Manhattan 2025 | Manhattan 2026 | Change | Northern NJ 2026 | Rest of NY 2026 | 2024 Medicare $ (NY+NJ) |
|---|---|---|---|---|---|---|---|
| 99214 | office | $142.07 | $153.27 | +7.9% | $150.65 | $130.88 | $45M |
| 99215 | office | $198.98 | $217.37 | +9.2% | $213.45 | $185.71 | $18M |
| 99213 | office | $101.06 | $107.63 | +6.5% | $105.93 | $91.86 | $12M |
| 99233 | facility | $127.61 | $118.89 | −6.8% | $115.66 | $104.06 | $9M |
| 96413 | office | $139.21 | $154.93 | +11.3% | $153.47 | $126.50 | $7M |
If a contract pays a percentage of the current year’s Medicare rate, the payer should have moved to the 2026 rates in January. You can check this on your remittances by comparing the allowed amount on a common code against the 2026 rate times your contract percentage.
99214 in Manhattan: $142.07 in 2025, $153.27 in 2026, a difference of $11.20.
A practice paid 140% of Medicare on 1,000 of these visits a year is owed $15,680 more in 2026 on that one code. If a payer is still applying last year’s schedule, that is the amount it is short.
For practices that do a lot of facility work it cuts the other way: a contract tied to current Medicare passes the 2026 facility cuts through. That is worth raising at renewal.
Commercial payers are not required to pay at or above Medicare. Medicare is used here because its rates are public, so anyone can check them.
The free floor check compares an 835 or A/R export against the published Medicare rate and shows what paid below it, by payer and by code. The file is read in your browser and is not uploaded.
Open the floor checkBilling companies can run the same check under their own name: claima.io/partners