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 99456

Status R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply. Release 2026 C · status R (Restricted)

Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service.

Why no amount for these inputs? View evidence

Code: 99456
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 R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply.

Citations

Identifies the PFS record checked for this result; the result reason above explains why no amount was computed from it.
Physician relative value file (PPRRVU)
Q3 2026 · revision 1

Latest revision of this release

Release period: July 1 – September 30, 2026

This 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 13,062)

hcpcs (col 1)

99456

modifier (col 2)

blank

status_code (col 4)

R

SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Original source file

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