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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

Payment locality: Chicago (IL) · 06102-16

Date of service
Date of service
CMS release

CMS release: 2026 D

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

Payment answer

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99213 CHICAGO flag Chicago (IL) Q4 2026 release
Locality-adjusted allowed amount
$99.63
in a doctor’s own office or clinic

104.7% of the $95.19 national baseline

Medicare share (80%)
$79.70
Sequestration (−2%)
−$1.59
Net Medicare payment
$78.11
Coinsurance (20%)
Owed by the patient or a secondary payer
$19.93
Expected total to provider
$98.04

Assumes the Part B deductible is met.

Date of service
Not supplied
Locality
CHICAGO flag Chicago (IL) · ZIP 60657
Setting
Office (non-facility)
Participation
Participating provider
CMS release
Q4 2026

( Work1.30 × 1.007 + Practice exp.1.46 × 1.005 + Malpractice0.09 × 2.295 ) × Conv. factor$33.4009 = $99.63

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