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Medicare fee schedule lookup and RVU calculator (2026)

Enter a HCPCS or CPT code and choose a payment locality, a ZIP code or national rates. The calculator reads the CMS October 2026 physician fee schedule relative value file (RVU26D, 18,481 code and modifier rows, not counting dental codes) and the 2026 geographic practice cost indices, and returns the work, practice expense and malpractice RVUs, the facility and non-facility payment at both conversion factors, the global surgery days and every payment policy indicator. Results stay on this page; nothing is stored.

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); ZIP code to carrier locality file: ZIP5 October 2026 (file updated August 13, 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 ZIP code to carrier locality file.

Where

Worked examples

Computed from the RVU26D store when this page was built, at the non-QP conversion factor $33.4009. Open a row to run it in the calculator above with both conversion factors and every indicator. NA marks a setting CMS flags as rarely or never used for the service; the file repeats the other setting's practice expense RVU there, so the amount shown is computed from that repeated value.

Medicare physician fee schedule amounts for example codes and localities, October 2026
CodeWhereWork / PE (non-facility) / MPNon-facilityFacilityGlobal
G2211National (GPCI 1.000)0.33 / 0.17 / 0.02$17.37$14.36ZZZ
G0439Manhattan, NY1.92 / 2.07 / 0.13$155.46$155.46 (NA)XXX
G0439Arkansas1.92 / 2.07 / 0.13$125.76$125.76 (NA)XXX
99213National (GPCI 1.000)1.30 / 1.46 / 0.09$95.19$57.45XXX
70473Locality 01112-05 (OPPS imaging cap)1.00 / 6.13 / 0.09$306.29$306.29 (NA)XXX

Take the first row: G2211 has 0.33 work, 0.17 non-facility practice expense and 0.02 malpractice RVUs, 0.52 in total. At national rates every GPCI is 1.000, so the non-facility amount is 0.52 x $33.4009 = $17.37, and $17.46 for a qualifying APM participant. The same code in Manhattan and in Arkansas shows how far the indices move a payment, and the last row is an imaging service whose payment is limited by the OPPS-based cap.

How the calculator works

Payment = [(work RVU x work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x conversion factor

This is the formula CMS prints in the relative value file documentation, applied with the published precision: RVUs to two decimals, GPCIs to three and the conversion factor to four, rounded to the cent at the end. For the technical component of certain imaging services, the amount is the lower of that result and the OPPS-based amount computed from the OPPS columns of the same file; the calculation reproduces all 6,322 capped amounts CMS publishes for priced codes in its OPPSCAP file. The limiting charge shown for non-participating clinicians is the fee schedule amount times 1.0925.

Conversion factor (non-QP)
$33.4009
Conversion factor (QP)
$33.5675
Payment localities
109
42,957 ZIP codes

Reading the indicators in a result

Each result names the status code first, because it decides whether there is a payment at all: in the October file 9,414 rows are active (A), 1,474 contractor priced (C), 2,577 statutory exclusions (X) and 276 anesthesia codes (J). The global surgery indicator gives the days of follow-up care included: 11,256 rows are XXX (no global period), 3,779 are 090 major surgeries, 469 are 010 minor procedures and 1,400 are 000 procedures with same-day care only. The PC/TC indicator says whether modifiers 26 and TC split the service; for codes that allow it, the result shows the global, professional and technical rows separately.

The multiple procedure indicator (5,405 rows carry the standard 100%/50% rule), the bilateral indicator (2,261 rows allow the 150% adjustment), and the assistant, co-surgeon and team indicators decide whether modifiers 51, 50, 80, 62 and 66 change the payment. The full distribution of every indicator, with CMS's definitions, is on the physician fee schedule page, and the GPCIs for each locality are in its GPCI table.

What the calculator does not do

It prices one unit of one code. It does not apply the multiple procedure, bilateral or imaging reductions that depend on other lines of the claim, the deductible, the 20% coinsurance most services carry, or sequestration. It does not price contractor-priced codes, and for anesthesia codes it gives the conversion factor but not the base units, which come from a separate CMS file. Hospital outpatient, ambulatory surgical center, DMEPOS and drug payments use other schedules: see the OPPS status indicators, the DMEPOS fee schedule and the ASP pricing file. Before a line is priced, the NCCI checker and the MUE lookup answer whether it bundles with another code and how many units can be paid.

Where QuickIntell fits beyond the calculator

The calculator prices one code at a time. Contract management in QuickRCM keeps payer contracts and fee schedules with their effective dates and compares expected reimbursement with allowed and paid amounts across the claim, with variances reviewed before a dispute.

See contract management in QuickRCMSee QuickCodeBook a meeting

Frequently asked questions

How do I calculate a Medicare payment from RVUs?

Multiply the work RVU by the locality's work GPCI, the practice expense RVU by the practice expense GPCI and the malpractice RVU by the malpractice GPCI, add the three products and multiply the sum by the conversion factor. Use the non-facility practice expense RVU for an office service and the facility one for a service in a hospital or ambulatory surgical center. The lookup does this for every code in the 2026 relative value file.

Why does the lookup show two payment columns?

Since 2026 Medicare has two physician fee schedule conversion factors: one for qualifying participants in advanced alternative payment models (QPs) and a slightly lower one for everyone else. The first payment column uses the non-QP factor, the second the QP factor.

Why do CPT codes appear without descriptions?

CPT descriptors are copyrighted by the American Medical Association and QuickIntell does not hold a license to publish them. RVUs, indicators and payment amounts are CMS payment data, so the lookup shows them for bare CPT numbers; HCPCS Level II codes link to their reference pages where one exists.

Why is there no payment for some codes?

Only codes with status A, R or T are paid from their RVUs. Contractor-priced codes (status C) are priced by the Medicare Administrative Contractor, anesthesia codes (status J) are paid from base and time units with the anesthesia conversion factor, bundled codes (B and P) are paid inside another service, and excluded or non-covered codes (E, N, X, I, M) are not paid under the physician fee schedule.

Does the amount include the multiple procedure or bilateral reduction?

No. The amount is the fee schedule amount for one unit of the service. The lookup shows the multiple procedure, bilateral, assistant, co-surgeon and team indicators so that the claim-level reductions can be applied, but it does not apply them, and it does not subtract the deductible, coinsurance or sequestration.

Can I use a ZIP code instead of a locality?

Yes. Choose ZIP code and enter five digits; the lookup resolves the ZIP to its Medicare carrier and payment locality from the CMS ZIP code file and prices the code there. A ZIP code split between localities by ZIP+4 is priced at the locality CMS assigns to the five-digit ZIP.

More Medicare payment files are on the fee schedules hub, including a ZIP code finder for payment localities.

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 calculator built from CMS public use files. Results are Medicare fee schedule amounts for one unit before claim-level adjustments; Medicare Advantage and commercial contracts set their own rates. CPT codes appear as bare numbers; CPT descriptors are copyright AMA and are not shown. 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.