CPT 36013 Medicare rate in Q1 2026

Contracted rate: % of Medicare Copy link

Commercial contracts are often written as a percentage of Medicare ("115% of Medicare"). Enter yours to see what it means for 36013. A contract benchmarked to the fee schedule applies it to your locality's allowed amount, not the $775.23 national baseline; the calculator finds that amount from your service ZIP.

See how to find your contract's actual percentage.

Rates by locality Copy link

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Look up your exact locality →

Q1 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 36013 has a work RVU of 2.46, a non-facility practice expense RVU of 20.35, a facility practice expense RVU of 0.50 and a malpractice RVU of 0.40—for total non-facility RVUs of 23.21 and total facility RVUs of 3.36 in the Q1 2026 release.

The formula is: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, never as zero.

Global period: what 36013's fee already covers Copy link

The global surgery concept does not apply to this code.

Billing policy Copy link

These billing-policy indicators explain how 36013 is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National Office (non-facility) amounts for the modifiers this code's indicators support. These are single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Not payable with 36013: -26/TC (professional/technical split); -50 (bilateral procedure); -80/81/82 (assistant surgeon (physician)); -AS (assistant at surgery (PA, NP, or CNS)); -62 (co-surgeons, each); -66 (team surgery).

Each amount applies a standard MPFS percentage (assistant surgeon 16%, non-physician assistant at surgery 13.6%, co-surgeon 62.5%, bilateral 150%) to the national Office (non-facility) amount above. CMS doesn't publish these as a column; Localis derives them, so check them against the current Medicare Claims Processing Manual before relying on them for payment.

CMS RVU26A · January 1 – March 31, 2026 See file rows

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for 36013 →

Payment review for 36013 Copy link

Three published payment rules can change what 36013 allows on a claim: the office/facility differential, the standard multiple-procedure reduction and the assistant-at-surgery prohibition. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Rate history by release Copy link

National Office (non-facility) amount for 36013 across quarterly releases. -8.9% decrease since Q1 2013 · peak $861.51 in Q1 2021

Why 36013's rate changed Copy link

National baseline (GPCI 1.000) · Office (non-facility) · Before sequestration

36013's national amount fell $75.69 (−8.9%), from $850.92 in Q1 2013 to $775.23 in Q1 2026. Changes to the conversion factor, which CMS sets for every code, took $15.56 off. CMS revaluing 36013 itself took $60.13 off: −$56.46 from practice-expense RVUs, −$2.00 from work RVUs and −$1.67 from malpractice RVUs. The most recent change came in Q1 2026: +$59.73 (+8.3%), with +$36.74 from practice-expense RVUs, +$23.32 from the conversion factor, −$2.00 from work RVUs and +$1.67 from malpractice RVUs.

CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.

How often 36013 is billed Copy link

Across Original Medicare in CY2024, 36013 ranked #4,955 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2026 fee schedule above.

How 36013 compares with other codes Copy link

Against every code with a national PFS amount in Q1 2026 · National baseline · Before sequestration

+590.8% Office over facility

36013's Office amount is $663.00 more than its facility amount, because a facility bills its own overhead separately. Of the 7,718 codes priced in both settings, 2,167 have a higher Office amount. 36013's gap is larger than 92% of theirs; the median gap is +78.1%.

60.3% Highest vs. lowest locality

36013's Office amount is 60.3% higher in its highest-paid payment locality than in its lowest. That spread is wider than 90% of the 7,689 codes compared; the median spread is 43.6%. How much a code's amount varies by locality depends on its mix of work, practice-expense and malpractice RVUs, since each has its own GPCI.

−8.9% Since Q1 2013

36013's Office amount fell 8.9% from Q1 2013 to Q1 2026. Over the same period, the median code's amount fell 6.6%. That's lower than the change for 63% of the 6,418 codes priced in both releases.

These comparisons cover every code with a national Physician Fee Schedule amount: status A, R or T, with no blank RVUs. The locality comparison leaves out codes with an OPPS cap, because the cap, not the GPCIs, can set their amount in some localities.