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Describe a service in plain words, or type a CPT/HCPCS code.

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Medicare expected-payment calculator

Enter a billing code, the service-location ZIP and the date of service. Get the Medicare allowed amount, how it splits between Medicare and coinsurance, and the CMS evidence behind each figure.

Claim details

CPT / HCPCS code
Service location
ZIP
Locality

Leave blank for the national baseline.

Date of service
Date of service
CMS release

CMS release: 2026 C

Place of service Office (non-facility) Facility
Modifiers: None
Supplied modifier

Select a supplied modifier. Click it again to remove it.

Code does not support a professional/technical split (PCTC indicator 0).
Code does not support a professional/technical split (PCTC indicator 0).
Bilateral procedure
Assistant-at-surgery is never separately payable for this code (statutory restriction).
Assistant-at-surgery is never separately payable for this code (statutory restriction).
Assistant-at-surgery is never separately payable for this code (statutory restriction).
Assistant-at-surgery is never separately payable for this code (statutory restriction).
Co-surgeon is not permitted for this code.
Team surgery is not permitted for this code.

Single-line modifiers only. Pricing -51? Use the MPPR calculator.

Payment answer

23930 A Active Save
Date of service
Not supplied
Locality
National (Gpci 1.000)
Setting
Office (non-facility)
Participation
Participating provider
CMS release
2026 C
National PFS baseline
$381.10
in a doctor’s own office or clinic
Medicare share (80%)
$304.88
Sequestration (−2%)
−$6.10
Net Medicare payment
$298.78
Coinsurance (20%)
Owed by the patient or a secondary payer
$76.22
Expected total to provider
$375.00

Assumes the Part B deductible is met.

Compare a remittance Check a remittance's allowed amount against this answer
Allowed amount on remittance
Payer paid
Optional: compare allocation, not just the allowed amount. Patient responsibility
Optional. If allowed is blank, payer paid + patient responsibility becomes the remittance allowed.
Commercial contract rate Model a contract paid as a percentage of Medicare
Your contract's % of Medicare For example, 115%.

Check a code mix · Find your percentage

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