Free 2026 Medicare Fee Calculator by State (No Signup Required)

Medicare Physician Fee Schedule payment for any CPT code is calculated as: Payment = [(Work RVU x Work GPCI) + (Practice Expense RVU x PE GPCI) + (Malpractice RVU x MP GPCI)] x Conversion Factor. The GPCI (Geographic Practice Cost Index) adjusts each RVU component by Medicare locality. Higher cost-of-living areas have GPCI values above 1.0, boosting payment 5 to 15 percent above the national rate. Lower cost-of-living areas have GPCI values below 1.0, reducing payment 5 to 10 percent. The same CPT 99213 visit pays around $88 in some localities and around $103 in others. For a practice with 1,000 established patient visits per month, that locality variation is meaningful. Knowing the actual rate for a specific code in a specific state is essential for fee schedule audit, contract negotiation, and revenue projection. Our free calculator at /tools/fee-calculator returns the 2026 rate by state in seconds.

Enter a CPT code. Optionally select a state. The calculator returns the 2026 Medicare payment for that code in that state, broken into facility versus non-facility settings, with the national rate (GPCI = 1.0) shown as a reference. The percent variance from national is calculated and displayed. The underlying RVU breakdown (Work, PE, MP) and the 2026 Conversion Factor ($33.4009) are shown so the math is transparent. The data is built on the CMS 2026 Physician Fee Schedule and the published GPCI values for each Medicare locality. We refresh the underlying data when CMS publishes updates. No signup is required; no payment is required; no rate-limited API call is made. Just look up the rate.

Use case one: fee schedule audit. Pull your top 25 to 50 CPT codes by volume from your billing system. Look up the 2026 Medicare payment for each in your state. Compare to what your billing system has stored as the expected Medicare allowable. If the variance is non-trivial, your fee schedule is stale and your CO-45 contractual write-offs are misaligned with reality. Update your billing system. Use case two: commercial payer contract negotiation. Most commercial payer contracts reference Medicare rates as a baseline (paid at 110 percent of CMS PFS for the date of service, etc.). When you negotiate a renewal, knowing the current Medicare rate for your high-volume codes lets you model the contracted rate accurately. Use case three: revenue projection. When the annual CMS PFS Final Rule is published with CF and RVU updates, look up the new rates for your top codes and multiply by your annual volume. The variance to prior year is your projected revenue impact in dollar terms.

Most CPT codes have two RVU sets: Non-Facility (services performed in private office, urgent care, ambulatory) and Facility (services performed in hospital, ASC, nursing home). The Practice Expense RVU is typically higher in the non-facility setting because the physician practice bears more of the practice cost. In the facility setting, part of the practice expense is paid to the facility (under separate Medicare facility payment) so the physician fee is lower. The non-facility rate vs facility rate gap can be 30 to 50 percent or more for procedure codes. For E/M codes, the gap is typically smaller. Our calculator shows both rates side by side so you can see the setting impact for any code.

The calculator shows the percent variance between the state-specific rate and the national rate. Some patterns to know. California, New York, Massachusetts, DC, Connecticut, New Jersey: GPCI values above 1.05, payment typically 5 to 15 percent above national. Wyoming, Montana, Mississippi, parts of the Dakotas: GPCI values below 0.95, payment typically 5 to 10 percent below national. Rural areas within larger states sometimes have separate rural Medicare localities with GPCI different from the urban areas of the same state. Texas, Florida, Pennsylvania: meaningful intra-state variation between metropolitan areas (Dallas, Houston, Miami, Tampa, Philadelphia) and rural areas. The state-level rate the calculator returns is generally the dominant locality for the state; for highly rural practices in mixed-locality states, look up the specific MAC locality if you need pinpoint accuracy.

The calculator returns Medicare payment based on the published 2026 Physician Fee Schedule. It does not address. Commercial payer rates. Most commercial payers reference Medicare as a baseline but pay above or below that baseline depending on contract. The calculator is a useful starting point for contract analysis but not a direct substitute for your specific commercial fee schedule. Sequestration. Medicare claims are subject to a 2 percent payment reduction under federal sequestration policy unless modified by legislation. The calculator returns the pre-sequestration rate. Medicare Advantage rates. MA plan rates are negotiated separately and may differ from traditional Medicare rates. Hospital outpatient (OPPS), ambulatory surgical center (ASC), and other non-PFS payment systems. The calculator covers Physician Fee Schedule only. Codes with status indicator B (bundled), N (non-covered), or other non-paid statuses do not have a calculable PFS rate and the calculator will return a $0 or N/A.

The calculator is most useful as part of a quarterly fee schedule audit cadence. Workflow: pull your top 50 CPT codes by volume from the billing system. For each, look up the 2026 Medicare rate in your state. Build a side-by-side comparison: what you billed, what Medicare allowed, what the calculator says Medicare should allow. Investigate the variances. Common findings: fee schedule in billing system is one or two years stale, commercial payer rate changed without notification (catches the cascade from Medicare CF changes), payer adjudication errors on specific codes worth disputing. Practices that run this audit quarterly catch fee schedule drift early. Practices that do not audit lose 1 to 3 percent of net revenue per year to stale rate references.

Our internal billing operations use the same CMS PFS data the calculator is built on. We maintain payer-specific fee schedule references for every client across all major payers, update them quarterly with each NCCI and PFS release, and run automated variance scoring on every EOB to catch payment errors and stale fee schedules before they age into write-off territory. The free calculator is the practice-facing version of the internal tools we use to manage client billing. Pricing for our managed billing service starts at 2.49 percent of net collections with no setup fees. The math: a typical practice has 5 to 15 dollars per visit in unrecovered Medicare and commercial payment errors that quarterly variance audit catches. Across 1,000 visits per month, that compounds quickly. Use the calculator at /tools/fee-calculator and the related lookup at /tools/cpt-lookup to verify any code's RVU and payment in seconds.