CPT code resources
Look up what Medicare pays for any CPT or HCPCS code, see which codes get billed most, and read the definitions and guides behind the numbers.
Popular: 99213 99213 Established Patient Office Visit, Level 3 Common for routine follow-up of one or two stable chronic conditions or a new but minor problem — think a blood-pressure check-in or a sprained ankle. View rate & details → 99214 99214 Established Patient Office Visit, Level 4 Common for managing multiple or worsening chronic conditions, starting a new prescription, or a problem that needs ongoing drug-therapy monitoring. View rate & details → 99203 99203 New Patient Office Visit, Level 3 Typical for a new patient with a single, uncomplicated problem or one stable condition being established with the practice. View rate & details → 93000 93000 Electrocardiogram (ECG), Complete Ordered to evaluate chest pain, palpitations, or as part of a routine cardiac work-up. View rate & details → 36415 36415 Routine Venipuncture (Blood Draw) Reported whenever blood is drawn by needle stick for laboratory testing, regardless of which tests are ordered on the sample. View rate & details →
Most-billed CPT codes
Not sure which code you're looking for? Browse the codes Medicare pays most often, ranked by patients reached and dollars paid.
Medicare's most-billed CPT codes → Ranked by beneficiaries reached and allowed dollars, every one linked to its current rate.Understand CPT & HCPCS
The glossary terms and guides that explain how a CPT code turns into a Medicare payment.
CPT (Current Procedural Terminology)
CPT is the numeric code set used to report medical procedures and services. It forms Level I of HCPCS and is maintained by the American Medical Association. Under the Physician Fee Schedule, most physician services are identified by a five-digit CPT code.
HCPCS vs CPT: What’s the Difference?
CPT and HCPCS are not competing code sets — CPT is Level I of HCPCS. When people contrast "HCPCS vs CPT" they usually mean the alphanumeric Level II codes (like J-codes for drugs) versus the numeric CPT codes for physician services. The practical differences are who maintains each set, what it covers, and who owns the descriptions.
PFS Status Indicators
A status indicator is a single-letter code that tells you how Medicare treats a service under the Physician Fee Schedule — whether it is separately payable, bundled into another service, carrier-priced, or not covered. Payability is driven by this status, not by whether a code happens to have RVUs.
How Medicare Pays: The PFS Formula
Medicare’s Physician Fee Schedule turns a code into a payment with one formula: multiply each RVU component by its geographic index, add them, and multiply by the conversion factor. Whether the code pays at all is decided first by its status indicator.
NCCI PTP Edits (Procedure-to-Procedure)
An NCCI Procedure-to-Procedure (PTP) edit is a CMS rule identifying pairs of HCPCS/CPT codes that generally cannot both be billed for the same patient on the same date of service. Each pair has a Column 1 and a Column 2 code, and a modifier indicator that says whether a modifier can legitimately bypass the edit.
How to Check a Medical Bill Against Medicare Rates
Every practice sets its own charges, so there is no master price list to compare a bill against. What you can do is run three checks that catch most billing problems: confirm the code matches the visit you remember, benchmark the charge against the Medicare amount for that code, and match the itemized bill line-by-line against your explanation of benefits (EOB).