Medicare Physician Fee Schedule 2026

2026 conversion factors

Conversion factor (non-QP)

$33.4009

Most clinicians

Conversion factor (QP)

$33.5675

Qualifying APM participants

Anesthesia CF, national (non-QP)

$20.49754

Anesthesia CF, national (QP)

$20.599835

Code and modifier rows

18,481

16,343 codes, dental codes excluded

Payment localities

109

55 contractor numbers, 53 states and territories

Since 2026 the fee schedule has two conversion factors. Clinicians who qualify as participants in an advanced alternative payment model (QPs) are paid with $33.5675 per RVU; everyone else is paid with $33.4009. CMS ships the two as separate relative value files. The non-QP file has 19,453 rows; 18,481 code and modifier rows remain once the 971 dental rows and 1 placeholder row are removed, and those are the rows this site uses. The QP file repeats only the rows with status A, C, R or T, the statuses under which a service can be paid: 11,033 rows without dental codes (A 9,414, C 1,474, R 137 and T 8), each carrying the QP factor. The figures above are read from the conversion factor column of those files rather than from a rounded press figure, and the payment amounts on this site use all four decimals.

Anesthesia services do not use RVUs. They are paid as base units plus time units multiplied by an anesthesia conversion factor, which CMS publishes nationally ($20.49754, or $20.599835 for QPs, both reflecting the 2.5% statutory increase named in the file) and for each locality. The locality factors run from $19.42 in Arkansas to $28.15 in Alaska; every locality's factor is in the GPCI table below.

What an RVU is and how the three components work

A relative value unit measures the resources a service uses relative to every other service on the schedule. Each code carries three: the work RVU for the clinician's time, skill and effort; the practice expense RVU for staff, supplies, equipment and overhead; and the malpractice RVU for professional liability insurance. Work RVUs are also the unit most practices use to measure clinician productivity, which is why "wRVU" shows up in compensation plans as well as on the fee schedule.

The practice expense RVU comes in two versions. The non-facility value applies when the service is furnished in an office or another setting where the practice pays the overhead; the facility value applies in a hospital, emergency department, skilled nursing facility or ambulatory surgical center, which is paid separately for its own costs. When a service is rarely or never furnished in one of the settings, CMS sets an NA indicator for that setting and repeats the other setting's practice expense value in its column: 4,077 rows carry NA for the non-facility setting and 2,743 for the facility setting.

Worked examples at national rates

For G2211, the non-facility total is 0.33 + 0.17 + 0.02 = 0.52 RVUs, and 0.52 x $33.4009 = $17.37 nationally. In a locality the three components are first multiplied by that locality's indices, which the RVU calculator does for any code.

The 2026 payment formula

CMS states the formula in the documentation that ships with each relative value file, once with the non-facility and once with the facility practice expense RVU. The result is the fee schedule amount for a participating clinician. Non-participating clinicians are paid 95% of it, and when they do not accept assignment the most they may charge the patient, the limiting charge, is 115% of that reduced amount, which equals the fee schedule amount times 1.0925. Medicare pays 80% of the allowed amount after the Part B deductible, and claim-level rules such as the multiple procedure reduction come on top.

The technical component of certain imaging services is capped at the hospital outpatient (OPPS) payment under section 5102(b) of the Deficit Reduction Act of 2005. The relative value file carries the practice expense and malpractice values used for that comparison on 1,042 rows (531 codes), and CMS publishes the capped amounts by locality in a separate OPPSCAP file. Computing the lower of the two amounts with the formula above reproduces all 6,322 capped amounts CMS publishes for priced codes to the cent, which is the check this reference runs on every build; the 8,938 OPPSCAP rows for contractor-priced codes are caps the contractor price cannot exceed, and the lookup shows them as published.

GPCI 2026: all 109 Medicare payment localities

The geographic practice cost indices adjust each RVU component to the cost of practising in a locality. The table lists every locality in the 2026 GPCI file with its contractor, the counties it covers (from the CMS locality-county file), the three indices, the geographic adjustment factor (GAF) and the locality anesthesia conversion factor. The GAF is a weighted average of the three indices using the cost shares CMS applies to them (work 50.866%, practice expense 44.839%, malpractice 4.295%); CMS publishes its own GAF table with the final rule, and rounding can differ in the third decimal.

Three floors shape the 2026 indices. The work GPCI cannot fall below 1.000 anywhere, a floor Congress extended through January 1, 2027; Alaska has a work GPCI floor of 1.500 under MIPPA; and the frontier states (Montana, Nevada, North Dakota, South Dakota, Wyoming) have a practice expense floor of 1.000 under the Affordable Care Act. The lowest geographic adjustment is Arkansas at 0.916, followed by Alabama and Mississippi; the highest is Alaska at 1.264, followed by San Jose-Sunnyvale-Santa Clara (San Benito County) (1.234).

Locality definitions and ZIP codes

16 states have more than one locality: California (29), Texas (8), New York (5), Illinois (4), Florida (3), Missouri (3), Georgia (2), Louisiana (2), Massachusetts (2), Maryland (2), Maine (2), Michigan (2), New Jersey (2), Oregon (2), Pennsylvania (2), Washington (2). Every other state is a single locality, although the District of Columbia locality also takes in the Maryland and Virginia suburbs of Washington. Localities are defined by county, and CMS maps every ZIP code to a contractor number and locality in a quarterly file: the October 2026 file has 42,957 ZIP codes in 59 state and territory codes, of which 11,635 are flagged rural, 7,829 super rural and 23,493 urban. 580 ZIP codes are split by ZIP+4 across localities, so for an address near a boundary the ZIP+4 file decides.

The rural flag in the physician fee schedule ZIP file is not the DMEPOS rural list. 434 ZIP codes on the quarter 4 DMEPOS rural list are urban in the PFS file, and 3,991 rural or super rural PFS ZIP codes are not on the DMEPOS list, which is why the finder reports both.

Status codes and payment policy indicators

The relative value file is more than a price list: each row carries a status code that says whether the RVUs are used for payment at all, and indicators that tell the contractor how to adjust the payment when the code is reported with others. Only rows with status A, R or T are paid from their RVUs, 9,526 rows in the October file. Contractor-priced codes (status C) have their price set by the Medicare Administrative Contractor, and anesthesia codes (status J) are paid with the anesthesia conversion factor.

Status codes

Global surgery days

The global period is the window of related pre- and postoperative care included in a procedure's payment. 20% of rows are major surgeries with a 90-day global period; 61% are services to which the concept does not apply.

Professional and technical components

Multiple procedures, bilateral surgery and surgical teams

These indicators drive the reductions applied when several procedures are reported on one date: modifier 51 ranks procedures and reduces the second and later ones, modifier 50 pays a bilateral procedure at up to 150% when the indicator allows, and modifiers 80, 62 and 66 are paid only where the assistant, co-surgeon and team indicators permit.

Contractors that price the localities

The 55 contractor numbers in the GPCI file belong to 7 Medicare Administrative Contractors. Each contractor also writes the local coverage determinations that decide whether a service is covered in its states.

Frequently asked questions

Related: the Medicare fee schedules hub, the MUE unit limits and the NCCI pair checker, which answer the other two questions a coded line raises before it is priced.

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.

• Medicare PFS national relative value file RVU26D (non-QPP), October 2026
  Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
• Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026
  Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
• CY2026 geographic practice cost indices by Medicare locality (Addendum E)
  Version CY2026 Addendum E (RVU26D) · effective 2026-01-01 · file GPCI2026.csvSHA-256 7850e2987d12e469…
• CY2026 anesthesia conversion factors by Medicare locality
  Version CY2026 (RVU26D) · effective 2026-01-01 · file ANES2026.csvSHA-256 c4d61aa421069986…
• Counties included in the 2026 Medicare payment localities (26LOCCO)
  Version CY2026 (RVU26D) · effective 2026-01-01 · file 26LOCCO.txtSHA-256 c1e3a394d641a207…
• PFS OPPS-based imaging payment caps by locality (OPPSCAP), October 2026
  Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file OPPSCAP_Oct.csvSHA-256 ba6752c6abeab5ad…
• ZIP code to carrier locality file (ZIP5), October 2026
  Version ZIP5 October 2026 (file updated 2026-08-13) · effective 2026-10-01 · file ZIP5_OCT2026.txtSHA-256 6892be209ade4324…
• DMEPOS rural ZIP code file, quarter 4 2026
  Version Q4 2026 · effective 2026-10-01 · file DME Rural Zip Code Quarter 4 2026.csvSHA-256 226616fbcbc4ace5…