Sources & calculation
Follow the rate back to its source.
A useful rate needs more than a dollar amount. You should be able to identify its service date, payment locality, setting and source—and see which calculations it does and does not include.
FeeBase is an independent reference service using CMS data. It is not affiliated with or endorsed by CMS.
On this page
Three components become one base rate
The physician fee schedule assigns RVUs for work, practice expense and malpractice. Each has its own geographic index. Multiply each pair, add the adjusted RVUs, then apply the conversion factor. CMS formula and documentation →
Worked example: 99214 in Chicago
Service date 2026-10-05 · Unmodified service · Standard / non-QP
Work
1.92 RVU
× 1.007 GPCI1.93344
Adjusted RVUs
Practice expense
2 RVU
× 1.005 GPCI2.01
Adjusted RVUs
Malpractice
0.14 RVU
× 2.295 GPCI0.3213
Adjusted RVUs
1.93344 + 2.01 + 0.3213 = 4.26474 adjusted RVUs
4.26474 × $33.4009
$142.45
Office / nonfacility base physician rate. The calculation retains decimal precision and rounds the final amount to cents.
Inspect the exact source rows
RVUs: PPRRVU2026_Oct_nonQPP.csv, row 13016.
Geographic indexes: GPCI2026.csv, row 48.
Open the CMS archive →Switch the setting to see the practice-expense input change. The facility figure is the physician’s fee-schedule amount; it is not a combined estimate of the physician and facility bills.
A city, ZIP and payment locality are different things
Payment locality is the geographic unit used for the rate’s indexes. Our city pages connect Census place and county boundaries to CMS locality definitions. A city can cross payment areas, so its page may show more than one result.
- Service ZIP
- The lookup uses a CMS ZIP-to-locality mapping. Some ZIPs require the four-digit extension; we ask for it rather than choose one payment area.
- Historical service date
- An exact-period ZIP mapping is preferred. If the lookup uses an earlier accepted mapping, it labels that fallback. It does not resolve an old service date using a later mapping.
- Known locality
- A locality selection prices the supplied contractor/locality identifiers directly. It does not prove that a particular service address belonged to that area on the requested date.
- City and state ranges
- These describe the supported payment areas in the selected geography. They are not utilization-weighted averages or a guarantee that every address has the same rate.
What the published amount includes
FeeBase currently models supported base participating-physician PFS rates. A missing result is a coverage boundary, not a conclusion that Medicare pays nothing.
Calculated
Active status-A source rows with supported standard calculations, the selected setting’s RVUs, locality indexes and applicable conversion factor.
Returned without an invented amount
Contractor-priced services, other unsupported payment statuses, unavailable settings, missing inputs, OPPS-capped rows and special-calculation rows.
Source-row modifiers
The contract checker can select a published modifier-specific rate row. It does not infer a professional or technical amount by splitting a whole-service price. Other modifiers may require rules we do not model.
Outside this base-rate calculation
Claim bundling, multiple-procedure reductions, sequestration, coverage decisions, patient deductibles or coinsurance, and a practice’s actual collections. Anesthesia and other payment schedules need their own rules and inputs.
The percentage and contract tools apply arithmetic to these base rates. Their offer totals are comparisons, not an adjudicated claim or a prediction of payer acceptance.
Dates and revisions are part of the answer
FeeBase preserves each imported source archive and checks its checksum. Import validation checks expected counts and required data before a release can be accepted. Accepted releases become available for their effective periods; importing a file alone does not publish it.
The service date selects the applicable period, and the highest accepted revision selects the correction within that period. The end date is exclusive. A newer revision can change the answer, so retain the release and revision alongside a saved rate.
Current example’s release record: RVU26D
- Effective from
- 2026-10-01
- End date (exclusive)
- 2027-01-01
- Revision
- 1
- Parser version
- cms-2026-v1
- Archive SHA-256
- 521ff0f4ecbf13b5d99dc1dc04d9f82e5361e55c6b4b6b3033043598bf8406e6
When two numbers disagree
- 01
Match the context
Compare the same code and modifier, service date, payment locality, office/facility setting and conversion-factor eligibility.
- 02
Check the source revision
A corrected file can differ from an older download covering the same period. The source row and release record help identify the difference.
- 03
Separate the base fee from the claim
A remittance, billed charge or commercial contract may include terms and adjustments absent from the base physician fee.
To report a discrepancy, include the code, locality, setting, service date and source reference. Do not send patient information.