Medicare expected-payment calculator

Enter one claim line. Localis resolves the applicable fee-schedule release and payment locality, then shows the expected allowed amount, Medicare payment, patient share, and source calculation.

Only have an RVU figure? Convert RVUs to dollars.

24546 2026 C · National (GPCI 1.000) A Active

Non-facility

Facility

Allowed amount

$953.60

in a doctor’s own office or clinic

Medicare payment: $762.88
Sequestration (−2%): −$15.26
Net Medicare payment: $747.62
Patient / secondary: $190.72
Expected total to provider: $938.34

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

RVU × GPCI components of this amount
Component	RVU	× GPCI	= Adjusted
Work	14.54	× 1.000	14.5400
Practice expense	11.01	× 1.000	11.0100
Malpractice	3.00	× 1.000	3.0000
Sum of adjusted RVUs			28.5500
× 33.4009 conversion factor			$953.60

Citations

Physician relative value file (PPRRVU) PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 2,274)

hcpcs (col 1)

24546

status_code (col 4)

A

work_rvu (col 6)

14.54

pe_rvu_nonfacility (col 7)

11.01

pe_rvu_facility (col 9)

11.01

mp_rvu (col 11)

3
Physician relative value file (PPRRVU) PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)

conversion_factor (col 26)

33.4009

CPT / HCPCS code

Modifiers

Code does not support a professional/technical split (PCTC indicator 0).

Bilateral procedure

Assistant surgeon (physician)

Minimum assistant surgeon (physician)

Assistant surgeon (no qualified resident)

Assistant at surgery (PA, NP, or CNS)

Co-surgeons

Team surgery is not permitted for this code.

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

ZIP

Locality

Preferred: resolves the Medicare payment locality for this line.

Release

Date

Used to select the release in effect on the claim date.

Need this programmatically?

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Pricing a commercial contract?

Use Contract Check for a weighted code mix instead of a single line-item multiplier.

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Checking more than one line?

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Compare a remittance

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.

Use a commercial contract based on Medicare

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage to see what 24546 pays at that rate.

Your contract's % of Medicare

For commercial contracts priced as a percentage of Medicare (for example, 115%).

Checking a whole code mix? Use Contract Check.

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See how to find your contract's actual percentage.

How Localis calculated $953.60

CMS 2026 C PFS · component math available

allowed = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor, using the non-facility practice-expense column.

Component	RVU	GPCI	Subtotal
Work	14.54	1.000	14.540
Practice expense (non-facility)	11.01	1.000	11.010
Malpractice	3.00	1.000	3.000
× conversion factor $33.4009 = allowed			$953.60

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