Medicare Fee Schedule Calculator
Medicare payment is a formula, not a guess. Enter any CPT or HCPCS code, choose your locality, and see exactly what Medicare allows for 2026 — with the full RVU math shown.
What Medicare allows for a service is not a mystery number. It is a published formula: relative value units (RVUs) for the code, adjusted for your locality's costs, multiplied by the national conversion factor. Enter a code below and see the full calculation for your Medicare locality — the same math your MAC uses.
Calculate a Medicare allowed amount
The formula
Payment = [(Work RVU × PW GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor. The practice expense (PE) RVU differs by setting: use the non-facility PE for office services and the (lower) facility PE when the place of service is a hospital or ASC, because the facility bills its own overhead separately. The CY 2026 conversion factor is $33.4009 for most clinicians and $33.5675 for Qualifying APM Participants (QPs).
Reading your result
- The allowed amount is the ceiling, not the deposit. Medicare pays 80% of it and the patient (or secondary payer) owes the remaining 20% after the annual deductible.
- Locality matters. The same code can pay 30% more in a high-cost locality and less in a rural one — always check the locality where the service was rendered.
- Commercial contracts are often quoted as a percentage of Medicare. Run the Medicare number first, then compare it with what the payer actually allowed on your remittance — a shortfall is an underpayment worth appealing.
Data source: CMS CY 2026 Physician Fee Schedule, Relative Value File RVU26D (October release) and the CY 2026 GPCI file. Amounts are the Medicare allowed amount before sequestration and before any multiple-procedure or other payment reductions. Verify coverage and policy with your MAC.
Frequently asked questions
What is the Medicare conversion factor for 2026?
For CY 2026 the Physician Fee Schedule conversion factor is $33.4009 for most clinicians, and $33.5675 for Qualifying APM Participants (QPs) in Advanced APMs. This calculator lets you switch between the two.
Why does the same code pay a different amount in another state?
Medicare adjusts each RVU component by a Geographic Practice Cost Index (GPCI) for the locality where the service was rendered. Rent, wages and malpractice premiums differ by market, so the work, practice expense and malpractice components are each scaled before the conversion factor is applied.
What is the difference between the facility and non-facility rate?
The non-facility rate (office setting) uses the higher non-facility practice expense RVU because the practice bears the overhead. The facility rate uses the lower facility PE RVU because the hospital or ASC bills its own costs separately. Picking the wrong setting is a common cause of apparent underpayments.