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.

Calculate the expected fee-schedule amount

Enter one line item. Localis resolves the release and locality, then shows the expected allowed amount, Medicare payment, and source math.

CPT / HCPCS code

Date of service

Used to select the MAC schedule effective on the claim date.

Service ZIP

ZIP

Locality

Required for carrier-priced codes unless you override the locality below.

Setting

Office / non-facility

Facility

+ Add modifier

Modifier

Single-line modifiers only. -51 requires a multi-line claim and belongs in the MPPR calculator.

Pricing -51? Use the MPPR calculator.

Advanced assumptions

2026 C · national baseline · standard conversion factor · sequestration on · par amount

Release override

Use only when checking an older adjudication or a specific quarter.

Manual locality override

No results found

No override

00 — Alabama (AL)

01 — Alaska (AK)

00 — Arizona (AZ)

13 — Arkansas (AR)

01 — Atlanta (GA)

31 — Austin (TX)

54 — Bakersfield (CA)

01 — Baltimore/Surr. Counties (MD)

20 — Beaumont (TX)

09 — Brazoria (TX)

16 — Chicago (IL)

55 — Chico (CA)

01 — Colorado (CO)

00 — Connecticut (CT)

11 — Dallas (TX)

01 — Dc + Md/Va Suburbs (DC)

01 — Delaware (DE)

01 — Detroit (MI)

12 — East St. Louis (IL)

71 — El Centro (CA)

03 — Fort Lauderdale (FL)

28 — Fort Worth (TX)

56 — Fresno (CA)

15 — Galveston (TX)

57 — Hanford-Corcoran (CA)

01 — Hawaii, Guam (HI)

18 — Houston (TX)

00 — Idaho (ID)

00 — Indiana (IN)

00 — Iowa (IA)

00 — Kansas (KS)

00 — Kentucky (KY)

18 — Los Angeles-Long Beach-Anaheim (Los Angeles/Orange County) (CA)

58 — Madera (CA)

01 — Manhattan (NY)

59 — Merced (CA)

01 — Metropolitan Boston (MA)

02 — Metropolitan Kansas City (MO)

01 — Metropolitan Philadelphia (PA)

01 — Metropolitan St. Louis (MO)

04 — Miami (FL)

00 — Minnesota (MN)

00 — Mississippi (MS)

60 — Modesto (CA)

01 — Montana (MT)

51 — Napa (CA)

00 — Nebraska (NE)

00 — Nevada (NV)

40 — New Hampshire (NH)

05 — New Mexico (NM)

01 — New Orleans (LA)

00 — North Carolina (NC)

01 — North Dakota (ND)

01 — Northern Nj (NJ)

02 — NYC Suburbs/Long Island (NY)

00 — Ohio (OH)

00 — Oklahoma (OK)

17 — Oxnard-Thousand Oaks-Ventura (CA)

01 — Portland (OR)

03 — Poughkpsie/N NYC Suburbs (NY)

20 — Puerto Rico (PR)

04 — Queens (NY)

61 — Redding (CA)

75 — Rest of California (CA)

99 — Rest of Florida (FL)

99 — Rest of Georgia (GA)

99 — Rest of Illinois (IL)

99 — Rest of Louisiana (LA)

99 — Rest of Maine (ME)

99 — Rest of Maryland (MD)

99 — Rest of Massachusetts (MA)

99 — Rest of Michigan (MI)

99 — Rest of Missouri (MO)

99 — Rest of New Jersey (NJ)

99 — Rest of New York (NY)

99 — Rest of Oregon (OR)

99 — Rest of Pennsylvania (PA)

99 — Rest of Texas (TX)

99 — Rest of Washington (WA)

01 — Rhode Island (RI)

62 — Riverside-San Bernardino-Ontario (CA)

63 — Sacramento-Roseville-Folsom (CA)

64 — Salinas (CA)

72 — San Diego-Chula Vista-Carlsbad (CA)

52 — San Francisco-Oakland-Berkeley (Marin County) (CA)

05 — San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) (CA)

65 — San Jose-Sunnyvale-Santa Clara (San Benito County) (CA)

09 — San Jose-Sunnyvale-Santa Clara (Santa Clara County) (CA)

73 — San Luis Obispo-Paso Robles (CA)

66 — Santa Cruz-Watsonville (CA)

74 — Santa Maria-Santa Barbara (CA)

67 — Santa Rosa-Petaluma (CA)

02 — Seattle (King County) (WA)

01 — South Carolina (SC)

02 — South Dakota (SD)

03 — Southern Maine (ME)

68 — Stockton (CA)

15 — Suburban Chicago (IL)

35 — Tennessee (TN)

09 — Utah (UT)

53 — Vallejo (CA)

50 — Vermont (VT)

00 — Virginia (VA)

50 — Virgin Islands (VI)

69 — Visalia (CA)

16 — West Virginia (WV)

00 — Wisconsin (WI)

21 — Wyoming (WY)

70 — Yuba City (CA)

Provider participation

Carrier-priced codes use the contractor's published par or non-par amount.

Apply sequestration to Medicare's portion

No expected amount for 93600

Carrier-priced codes require a specific Medicare locality. Select one below; there is no national MAC amount. Release 2026 C · status C (Carrier-priced)

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

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