Medicare expected-payment calculator

Enter a code, service location, and date to calculate an allowed amount with CMS evidence.

Claim details

CPT / HCPCS code

Location

Date of service

CMS release: 2026 C

Place of service

Office (non-facility)

Facility

Modifiers: None

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

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

Bilateral adjustment does not apply to this code (indicator 0).

Payable only if supporting documentation establishing the medical necessity of an assistant at surgery is submitted.

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.

No expected amount for 98000

Status I is not separately payable under the PFS. Release 2026 C · status I (Not valid)

Medicare uses a different code to report and pay for this service.

Why no amount for these inputs? View evidence

Code: 98000
DOS: Not supplied
Locality: National (GPCI 1.000)
Service ZIP: Not supplied
Setting: Office (non-facility)
Participation: Participating provider
Modifiers: None
Units: 1
Release: Q3 2026, revision 1
Sequestration: Shown separately from the allowed amount

Status I is not separately payable under the PFS.

Citations

Establishes the PFS status of the base code.
Physician relative value file (PPRRVU)
Q3 2026 · revision 1

Latest revision of this release

Release period: July 1 – September 30, 2026

This status record alone does not establish an allowed amount or a coverage determination.

Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,859)

hcpcs (col 1)

98000

modifier (col 2)

blank

status_code (col 4)

I

SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Original source file

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