Medicare Fee Schedule Rates

This connector looks up what the Medicare Physician Fee Schedule allows for a CPT or HCPCS code on a date of service. A call takes up to 25 lines (code, optional modifier, date of service), an optional state and locality, and an office or facility setting. Each answer gives the Medicare national figure and the state range or one locality's figure, the quarterly CMS release in force on that date, the CMS source files with their SHA-256 checksums, and the formula, so the figure can be checked against the CMS file.

A second tool lists every CMS release the archive holds, with effective dates, source files, checksums and any gaps in coverage. The exact span of dates covered is in that list.

What an amount is: the Medicare-allowed amount per unit, before the 2% sequestration reduction and before multiple-procedure reductions. These are Medicare national and locality amounts taken from CMS files. They are not a prediction of what any commercial payer, auto policy or workers' compensation plan pays, and they are not an opinion on whether a charge is reasonable.

A code with no national rate on the schedule (bundled, carrier-priced, laboratory, drug, anesthesia, ambulance, supplies, or absent from that release) returns a reason instead of a figure. The connector does not cover hospital outpatient or inpatient payments, ambulatory surgery center fees, Medicaid, or CPT code descriptions.

No sign-in and no account are needed. The connector is read-only. It records the tool called, the code, the state, the CMS release, the result type, the number of lines, a coarse client label and a time stamp, and keeps these records for 24 months. It does not record the date of service, the IP address or the caller's location. See the privacy policy for the full statement.

This connector is not certified by, affiliated with or endorsed by CMS.