Medicare Reimbursement Rates by Code and ZIP (2026)

Medicare reimbursement rates for a billing code depend on three things: where the service happens, when it happens and in what setting. Enter your codes and a ZIP below to see the Medicare Physician Fee Schedule allowed amount for each one at your payment locality, on your date of service, with the calculation and the exact CMS file rows behind every number.

Paste a whole code list (up to 25 at once), switch between office and facility, add a contract percentage, and export the result as a CSV. The link in your address bar updates as you go, so you can send a coworker the exact lookup you're looking at.

How to look up a Medicare reimbursement rate

1. Add your codes. Search by code or description, or paste a list separated by spaces, commas or new lines. Common sets (office visits, new patients, wellness, therapy) are one click away.
2. Set the ZIP where the service is performed. Use the location of the office or facility, not the patient's home. The lookup shows which Medicare payment locality the ZIP maps to.
3. Pick the date of service. It defaults to today. Older and future dates use the CMS release that was or will be in effect.
4. Choose the setting. Non-facility for your own office; facility for a hospital outpatient department, ambulatory surgical center or skilled nursing facility.
5. Add your contract rate (optional). Pick a percentage of Medicare to add a column priced at that share, the quickest way to turn "110% of Medicare" into dollars.

Every code chip in the results links to that code's page for your locality, where you'll find its history, its range across the country and the billing rules that apply to it.

How Medicare calculates the rate

Each code carries three relative value units (RVUs) from CMS: physician work, practice expense and malpractice. Each RVU is multiplied by the geographic practice cost index (GPCI) for your locality, the three products are added, and the total is multiplied by the conversion factor. The formula is in the Medicare Claims Processing Manual, Chapter 12, §20.1:

Allowed amount = [(RVUw × GPCIw) + (RVUpe × GPCIpe) + (RVUmp × GPCImp)] × CF

The lookup does this arithmetic on the server with exact decimals and rounds to the cent only at the end, the same way CMS does. Expand any row to see the inputs, then the highlighted line in the CMS relative value file, the GPCI file and the ZIP-to-locality file they were read from.

Why the same code pays differently

Location

Medicare divides the country into payment localities. Some states are a single locality; others split major metro areas from the rest of the state. Each locality has its own work, practice expense and malpractice GPCI, so the same code can differ by a meaningful amount between a rural and an urban locality in the same state. Browse every payment locality to compare.

A handful of ZIP codes cross locality lines. CMS assigns those by ZIP+4, and the lookup will ask for the four-digit extension when it needs it.

Setting

The practice expense RVU has two values. The non-facility value covers the cost of running an office: staff, rent, equipment and supplies. The facility value is lower because the hospital or surgery center is paid separately for that overhead. Switch the setting below to see the gap for a mid-level office visit:

Some codes are only priced in one setting. Major surgery like a total knee replacement has no non-facility rate, so the lookup shows a status and a one-click switch to the facility rate.

Date of service

CMS publishes the fee schedule as quarterly releases. January brings the new year's conversion factor and RVUs; later releases correct values and add codes. The lookup uses the release in effect on your date of service and shows its label at the top, so a claim from last spring is priced with last spring's numbers.

Participation

From 2026 there are two conversion factors: one for clinicians who are qualifying participants in an Advanced Alternative Payment Model (QP) and one for everyone else. Most practices should leave the lookup on non-QP. For 2025 dates there's a single conversion factor, and the setting has no effect.

What the number is and isn't

The lookup returns the Medicare Physician Fee Schedule allowed amount for a participating clinician: what Medicare allows for one service before claim-level adjustments. It doesn't include:

• Patient cost sharing. Medicare pays 80% of the allowed amount after the Part B deductible; the patient owes the rest.
• Non-participating or limiting-charge amounts. Non-participating clinicians are paid 95% of the fee schedule amount.
• Provider-type reductions. Nurse practitioners, physician assistants, clinical social workers and some other clinicians are paid a share of the fee schedule. See reimbursement by provider type.
• Modifiers and multiple-procedure rules. Bilateral, assistant-at-surgery and multiple-procedure reductions change the amount on the claim. See the modifier guides and the therapy MPPR calculator.
• Sequestration and other payment adjustments applied when the claim is processed.

Codes that Medicare doesn't price on the physician fee schedule show a status instead of an amount: contractor-priced codes, codes paid under another fee schedule and codes not valid for Medicare.

Using the results

• Export CSV saves every row with the ZIP, locality, date, setting, release label and the SHA-256 of each source file, so the sheet documents itself.
• Contract column. Choose a percentage of Medicare to price a payer offer against Medicare line by line. For a volume-weighted comparison, use the contract check.
• Share. Copy the address bar. The link holds your codes, ZIP, date, setting and percentage.
• Go deeper. Each code links to its page for your locality: rate history, how it compares nationally, payment indicators and related codes.

Need a full sheet for a specialty instead? Start from a ready-made list for primary care, physical therapy or behavioral health.

FAQ

What is the Medicare reimbursement rate for a CPT code?

It's the Medicare Physician Fee Schedule allowed amount for that code at the locality where the service is performed, in the setting it's performed, on the date of service. Enter the code and your ZIP above to see it, with the calculation and sources.

Do Medicare rates vary by ZIP code?

Yes. Each ZIP maps to one of Medicare's payment localities, and each locality has its own geographic cost indexes. The lookup shows which locality your ZIP maps to.

Is the Medicare allowed amount what the patient pays?

No. Medicare pays 80% of the allowed amount after the Part B deductible, and the patient or their supplemental plan owes the remaining 20%.

Why does a code show a status instead of a price?

CMS doesn't publish a fee schedule amount for it in that setting or release. It may be facility-only, contractor-priced, paid under another fee schedule or not valid for Medicare. The status explains which.

How current are the rates?

The lookup uses the CMS release in effect on your date of service and shows its label and effective date. New quarterly releases are added when CMS publishes them.