Medicare expected-payment calculator

Enter a code, ZIP and date of service to get the allowed amount and the CMS rows behind it.

CPT / HCPCS code

5 don't apply to 99213

-26 Professional component. Code does not support a professional/technical split (PCTC indicator 0).
-TC Technical component. Code does not support a professional/technical split (PCTC indicator 0).
-50 Bilateral procedure. Bilateral adjustment does not apply to this code (indicator 0).
-62 Co-surgeons. Co-surgeon is not permitted for this code.
-66 Team surgery. Team surgery is not permitted for this code.

One modifier per line. Pricing -51? Use the MPPR calculator.

Service location

Leave blank for the national baseline.

Date of service

CMS release: 2026 D ·

Place of service

Office (non-facility) Facility

Billed by Physician (MD/DO)

Rendering provider

The allowed amount for the service location and setting, or the national PFS baseline when no location is entered
The Medicare share after sequestration, the coinsurance, and the expected total to the provider
The CMS release, file rows and formula behind every figure, with a link to reproduce it

Coverage and coding correctness are outside this calculation.

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