Medicare Fee Schedule Calculator

Medicare Fee Schedule FAQ

Everything you need to know about 2026 Medicare reimbursement rates

What is the 2026 Medicare conversion factor?

The 2026 Medicare conversion factor is $32.7476 per RVU (Relative Value Unit). This is the dollar amount that Medicare pays for each RVU. The total reimbursement is calculated by multiplying the total RVUs (work + practice expense + malpractice) by this conversion factor, adjusted for your geographic location using GPCI values.

How do I calculate Medicare reimbursement rates?

Medicare reimbursement is calculated using this formula:

Our calculator automatically applies all GPCI adjustments based on your selected state and locality, so you get accurate reimbursement rates instantly.

What is the difference between facility and non-facility rates?

Non-facility rates apply when services are performed in a physician's private office or freestanding clinic. These rates are typically higher because the practice bears all overhead costs (equipment, staff, supplies).

Facility rates apply when services are performed in a hospital, ambulatory surgery center (ASC), or other institutional setting. These rates are lower because the facility receives a separate payment to cover overhead costs.

Example: CPT 99213 pays approximately $98 in a non-facility setting but only $72 in a facility setting—a 26% difference.

Are 2026 Medicare rates higher or lower than 2025?

The 2026 Medicare Physician Fee Schedule includes both increases and decreases depending on the specific CPT code. CMS annually adjusts RVUs based on practice cost surveys, utilization patterns, and congressional mandates. Some E/M codes saw increases, while certain procedures saw reductions. Use our calculator to compare current rates for your most-billed codes.

What are GPCI values and why do they matter?

GPCI (Geographic Practice Cost Indices) adjust Medicare payments based on local costs in your area. There are three GPCI values:

• Work GPCI: Adjusts for wage differences for physicians and staff
• Practice Expense GPCI: Adjusts for office rent, equipment, and supplies
• Malpractice GPCI: Adjusts for liability insurance costs

For example, New York City has higher GPCIs than rural Alabama, reflecting higher costs of practicing medicine in metropolitan areas.

How often does Medicare update fee schedules?

Medicare updates the Physician Fee Schedule annually, typically effective January 1st. CMS publishes the final rule in November of the preceding year. Throughout the year, CMS may also issue quarterly updates for new CPT codes or corrections. Our calculator is updated promptly when CMS releases new rates.

Does this calculator include all CPT codes?

Our calculator includes 10,000+ CPT codes covering all major specialties including evaluation and management (E/M), surgery, radiology, pathology, anesthesia, and more. If you need a specific code that's not listed, contact us and we'll add it within 24 hours.

What if my actual Medicare payment is different from the calculator?

Several factors can cause variations:

• Sequestration: 2% automatic reduction on all Medicare payments
• Modifiers: Can increase or decrease payment (e.g., -25, -59, -TC)
• Bundling rules: Some codes can't be billed together
• Quality adjustments: MIPS/QPP performance can affect payment
• Locality misclassification: Verify your MAC's designated locality

Our calculator shows the base Medicare allowable. Your actual payment may vary based on these factors.

Can I use this calculator for Medicare Advantage plans?

Medicare Advantage (MA) plans are not required to follow traditional Medicare fee schedules. Most MA plans negotiate their own rates with providers, which can be higher or lower than original Medicare. However, many MA plans use Medicare rates as a baseline (e.g., "Medicare + 10%"), so this calculator can give you a reference point. Always verify rates with individual MA plans.