How is the Medicare payment for a CPT code calculated?

Each code carries three relative value units — physician work, practice expense, and malpractice. Their sum is multiplied by the annual conversion factor ($33.4009 for 2026, or $33.5675 for qualifying APM participants) and adjusted by geographic indices (GPCIs) for your locality. Medicare then pays 80% of the allowed amount; the patient or secondary coverage owes 20%.

Why are facility and non-facility rates different?

Non-facility rates apply when the practice bears the overhead (office settings) and include higher practice-expense RVUs. Facility rates apply in hospitals and ASCs where the facility bills its own fee, so the physician payment is lower.

Are these the exact amounts I will be paid?

These are national amounts from the official CMS January 2026 file, before geographic adjustment. Your locality's GPCIs move the number up or down a few percent, sequestration reduces the paid portion by 2%, and Medicare pays 80% with 20% patient responsibility. Medicare Advantage plans set their own rates, often anchored to a percentage of these values.

Free tool · Official CMS January 2026 data · 19,226 codes

2026 Medicare Fee Schedule Lookup

Enter any CPT or HCPCS code — or search by keyword — and see the 2026 national Medicare payment, facility vs non-facility, with the full RVU breakdown and global period. Built directly from the official CMS Physician Fee Schedule January 2026 release, using the final $33.4009 conversion factor.

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Show qualifying-APM rates ($33.5675 CF) instead of standard ($33.4009)

Getting paid less than these numbers?

Between MA plan discounts, bundling edits and underpayments, most practices collect below the schedule without knowing it. Our free audit benchmarks your actual payments against the fee schedule.

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Reading the numbers

National, before locality. Amounts shown are national — your Medicare Administrative Contractor applies geographic indices (GPCIs) that move payment up or down a few percent by locality. Sequestration trims the paid portion by 2%, and Medicare pays 80% of the allowed amount with 20% patient responsibility.

Facility vs non-facility. Office-based services use the higher non-facility rate because the practice bears the overhead; hospital and ASC settings use the facility rate. Billing the wrong place of service is a classic underpayment source — see our POS code guide.

RVUs are the engine. Work + practice expense + malpractice RVUs × conversion factor = payment. Our RVU guide explains how the pieces work, and the E/M coding guide covers the office-visit codes that dominate most fee schedules.