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Medicare fee schedules 2026

Original Medicare does not pay from one price list. A professional claim is priced from the physician fee schedule, an equipment claim from the DMEPOS schedule, a drug line from the quarterly ASP payment limits, and a hospital outpatient line through OPPS, where a status indicator decides whether the line pays at all. This hub collects the 2026 files behind each of them, read directly from the CMS downloads, with the conversion factor, the geographic indices for every payment locality, and a finder that returns the locality for any ZIP code.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); PFS GPCIs, anesthesia conversion factors and localities: CY2026 Addendum E (RVU26D) (effective January 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); ASP payment limits: October 2026 (effective October 1, 2026); I/OCE data tables (edits, status and payment indicators): I/OCE v27.3 (October 2026) (effective October 1, 2026). Next CMS release: RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; CY2027 PFS final rule (November 2026), effective January 1, 2027 for the PFS GPCIs, anesthesia conversion factors and localities; January 1, 2027 (quarterly update) for the DMEPOS fee schedule and ASP payment limits; January 1, 2027 (quarterly I/OCE release) for the I/OCE data tables (edits, status and payment indicators).

TL;DR

Medicare pays Part B services from several fee schedules. For 2026 the physician fee schedule converts RVUs to dollars at $33.4009 (or $33.5675 for qualifying APM participants) and adjusts them across 109 payment localities; the October DMEPOS schedule prices 2,127 equipment and supply codes by state; OPPS status indicators decide how 18,431 hospital outpatient codes are paid; and the quarterly ASP file sets payment limits for 918 Part B drug and biological codes.

2026 figures at a glance

PFS conversion factor
$33.4009
Clinicians who are not qualifying APM participants
Qualifying APM conversion factor
$33.5675
Qualifying APM participants (QPs)
Anesthesia conversion factor
$20.49754
QPs $20.599835
Payment localities
109
42,957 ZIP codes mapped
DMEPOS codes priced
2,127
14 payment categories
Part B drug codes with a limit
918
October 2026 ASP file

Which fee schedule prices which claim

The billing form and the provider type decide the schedule. A physician billing an office visit uses the PFS non-facility amount; the same visit in a hospital clinic is split between the PFS facility amount for the physician and an OPPS payment for the hospital.

Medicare Part B fee schedules and payment systems covered by this reference
ScheduleWho it paysHow the amount is setUpdates
Physician fee schedule (PFS)Physicians, nonphysician practitioners and therapists billing professional services on the 837PRVUs x locality GPCIs x $33.4009January rule; quarterly RVU corrections
DMEPOS fee scheduleSuppliers of durable medical equipment, prosthetics, orthotics and suppliesStatewide non-rural and rural amounts per code and modifierQuarterly
ASP drug payment limitsPart B drugs and biologicals billed by physicians, suppliers and hospitalsUsually 106% of the average sales price per billing unitQuarterly
OPPS and ASC indicatorsHospital outpatient departments (837I) and ambulatory surgical centersAPC payment rates; the status or payment indicator decides whether a line paysQuarterly addenda
Seasonal vaccine allowancesAnyone administering influenza or COVID-19 vaccine to Part B patients95% of average wholesale price, set per seasonAugust to July

Clinical laboratory tests have their own schedule (the CLFS), and inpatient stays are paid per discharge under MS-DRGs, which the MS-DRG reference covers with FY2027 weights. Ambulance, home health, hospice and skilled nursing facility services are paid under their own fee schedules or prospective payment systems and are not part of this hub.

Find the Medicare payment locality for a ZIP code

Every PFS payment is adjusted to one of 109 payment localities. Most states are a single statewide locality; 16 states, led by California (29), Texas (8), New York (5), are split into metropolitan localities and a rest-of-state locality. CMS assigns each ZIP code to a contractor and locality in its quarterly ZIP code file, which the finder below reads. It also shows the PFS rural flag for the ZIP and, separately, whether the ZIP is on the DMEPOS rural list, because the two lists are not the same.

The geographic adjustment runs from 0.916 in Arkansas to 1.264 in Alaska, so for a service with the average mix of work, practice expense and malpractice RVUs the highest-cost locality pays about 38% more than the lowest. The full table of work, practice expense and malpractice indices, the counties in each locality and the contractor that serves it are on the GPCI table for all 109 localities.

How a 2026 physician fee schedule amount is calculated

Each service has three relative value units: physician work, practice expense and malpractice. Each is multiplied by the matching geographic practice cost index for the locality, the three products are added, and the sum is multiplied by the conversion factor. For 2026 CMS publishes two factors, $33.4009 for most clinicians and $33.5675 for qualifying alternative payment model participants, and the RVU26D file carries 16,343 HCPCS and CPT codes, not counting dental codes. The practice expense RVU differs by setting: the non-facility value applies in an office, the lower facility value in a hospital or ambulatory surgical center.

The Medicare fee lookup and RVU calculator runs that arithmetic for any code at any locality or ZIP code and shows the global surgery days and the multiple procedure, bilateral, assistant, co-surgeon and team indicators that change what a claim actually pays. The 2026 physician fee schedule page explains each RVU component and indicator and shows the distribution of codes across them.

Fee schedule pages

When the fee schedules change

The physician fee schedule is set once a year: CMS publishes a proposed rule in July, a final rule around the start of November and the January relative value file (the A file) for services on or after January 1. The same year's file is then re-issued in April, July and October as the B, C and D files when CMS corrects values, adds codes or implements legislation; this reference uses the October 2026 release, RVU26D. The DMEPOS, ASP, OPPS and ASC files follow the quarterly cycle (January, April, July, October), and the seasonal vaccine price file runs from August 1 to July 31. Each page shows the release it was built from and the next scheduled release, and says so when a newer CMS file was due.

For the effect of the 2026 conversion factors and the efficiency adjustment on a practice's own service mix, the article CMS 2026 physician fee schedule: assess your revenue impact sets out a fixed-volume comparison method. Denials that cite a fee schedule rule (for example an assistant-at-surgery or bilateral restriction) appear on the remittance as claim adjustment reason codes; the denial code reference explains each one.

Where QuickIntell fits with fee schedules

Contract management in QuickRCM organizes payer contracts and fee schedules with their effective dates and compares expected reimbursement with allowed and paid amounts, so a variance is reviewed, and entitlement confirmed, before anyone opens a dispute. Payment posting carries the remittance side of the same comparison.

See contract management in QuickRCMSee payment postingBook a meeting

Frequently asked questions

What is the Medicare fee schedule for 2026?

There is no single Medicare fee schedule. Physician and other professional services are paid from the physician fee schedule (conversion factor $33.4009, $33.5675 for qualifying APM participants); durable medical equipment, prosthetics, orthotics and supplies from the DMEPOS fee schedule; Part B drugs from the quarterly ASP payment limits; and hospital outpatient services from OPPS, where the status indicator decides whether a code is paid at all.

How do I look up the Medicare fee for a code in my area?

Find your payment locality (the ZIP finder on this page returns it for any of 42,957 ZIP codes), then enter the code and locality in the Medicare fee lookup. It applies that locality's geographic practice cost indices to the code's RVUs and returns facility and non-facility amounts with the payment policy indicators.

How often do the fee schedules change?

The physician fee schedule changes every January 1 with the final rule and is re-issued in April, July and October when CMS corrects RVUs. DMEPOS, ASP, OPPS and ASC files are quarterly. The seasonal vaccine price file runs August through July.

Do commercial payers use these amounts?

Many commercial and Medicare Advantage contracts pay a percentage of a Medicare fee schedule, but which year, locality and amendment they reference is a contract question. The amounts here are original Medicare amounts before deductible, coinsurance and sequestration.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from CMS public use files. Amounts are original Medicare fee schedule amounts before the deductible, coinsurance, sequestration and claim-level adjustments; Medicare Advantage and commercial contracts set their own rates. CPT codes, where they appear, are bare numbers; CPT descriptors are copyright AMA. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.