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.

No expected amount for G0472

Status X is not separately payable under the PFS. Release 2026 C · status X (Statutory exclusion)

The statutory definition of physician services does not include this item.

CPT / HCPCS code

Modifiers

Code does not support a professional/technical split (PCTC indicator 3).

Bilateral adjustment concept does not apply to this code.

Assistant-at-surgery concept does not apply to this code.

Co-surgeon concept does not apply to this code.

Team surgery concept does not apply to 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.

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