Methodology

Every reimbursement value on this site is calculated deterministically from the publicly available CMS Medicare Physician Fee Schedule (MPFS) data files. We do not estimate, smooth, or modify CMS values; we apply the published formula and round half-to-even at two decimals to match the CMS payment system.

The formula

Allowed Amount =
  ((Work RVU × Work GPCI)
   + (Practice Expense RVU × PE GPCI)
   + (Malpractice RVU × MP GPCI))
  × Conversion Factor

Inputs we use

• RVU values from the CMS PPRRVU file for the year shown on each page (the 2026 file for 2026 pages).
• GPCI values from the CMS GPCI file, mapped to the state's primary Medicare locality.
• Locality crosswalk from the CMS LOCCO file (ZIP code to MAC locality).
• Conversion factor: 32.3465 for 2026, sourced from the CMS Physician Fee Schedule Final Rule.

Scope

We publish reimbursement values for HCPCS Level II codes only — the Medicare-specific G-codes, J-codes for drugs, A-codes and B-codes for supplies, and E/K/L-codes for durable medical equipment. We do not publish AMA-licensed CPT codes.

Caveats

• Final claim payment depends on patient-specific cost-sharing, sequestration, MIPS adjustments, and the specific MAC pricing rules for the service.
• DME, drug, and supply codes may be paid under separate fee schedules (DMEPOS, Part B drug ASP) that override the standard PFS calculation.
• Always confirm exact payment with your Medicare Administrative Contractor.

Update cadence

The CMS PFS Final Rule is published in November. We refresh the entire rate matrix within the first weeks of each calendar year, plus any quarterly HCPCS Level II updates issued by CMS.