Percent of Medicare Calculator: Check a Payer Contract

Percent of Medicare is a payer's allowed amount for a code divided by Medicare's allowed amount for the same code, locality, setting and year, times 100. A commercial rate equal to the Medicare rate is 100% of Medicare; 25% more is 125%. For a whole contract, weight each code by your volume, because a high percentage on a code you rarely bill moves your revenue far less than a small cut on your most common visit.

Use the contract check below to compare a payer's offer with Medicare for your payment locality. Enter an offer as a percentage of current Medicare or as flat dollars per code, add your codes and annual volumes, and see the weighted result and the yearly difference against Medicare.

How to calculate percent of Medicare

1. Pick the payment locality. Medicare rates vary by locality through the GPCIs. Use the one where you provide the service.
2. Pick the setting. Office services are compared with Medicare's non-facility rate; services in a hospital outpatient department or ASC with the facility rate.
3. Get the Medicare allowed amount for each code from the same release the contract refers to.
4. Divide the payer's rate by Medicare's rate and multiply by 100 for each code.
5. Weight by volume. Multiply each payer rate and each Medicare rate by your annual units, add each column, and divide the totals. That's the contract's effective percent of Medicare.

Here's the baseline for one code. Enter your ZIP to swap the national rate for your locality's:

Why the weighted percentage is the one that matters

Take an offer that pays 120% of Medicare on 99215, 105% on 99213 and 98% on 99214. The simple average is about 108%. But if 99214 is your most-billed visit, most of your revenue sits at 98%, and the weighted figure lands well below 108%. Payers know this: rich rates on rarely billed codes make an offer look better than it is. The contract check weights by your actual volumes, and the comparison below shows how far apart the three visit levels sit before any percentage is applied.

Choosing the right Medicare baseline

Most disputes over "percent of Medicare" are really disputes over which Medicare number. Settle these before comparing:

Reading a "percent of current Medicare" contract

A contract tied to current Medicare changes automatically every time CMS updates the fee schedule. For 2026 the conversion factor rose 3.26% for most clinicians (CMS CY 2026 PFS final rule fact sheet), but individual codes moved by different amounts because RVUs changed too, including a 2.5% efficiency cut to work RVUs for many procedures. A contract fixed to an older year's schedule doesn't move at all. When you renegotiate, rerun your top codes against the current release and the contract's base year to see what that choice is worth.

Check also how the payer applies Medicare's payment rules on top of the percentage. Many contracts adopt Medicare's multiple procedure reductions, modifier adjustments and site-of-service rules. If yours does, the effective rate for a surgery with modifier 51 or a therapy visit under the therapy MPPR is the percentage of the reduced Medicare amount, not the full one.

Sources: CMS Pub. 100-04, Chapter 12, §20.1 and §20.4.1; CY 2026 Medicare Physician Fee Schedule final rule fact sheet (CMS-1832-F); Medicare.gov Part B costs (2026). Verified October 6, 2026.