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CPT 76018 Medicare rate in Q2 2025

Office (non-facility) & facility

Historical · Q2 2025
$111.60

National (GPCI 1.000)

Office-only: CMS developed no facility practice-expense RVUs for 76018 (NA indicator), so the file’s facility amount repeats the Office (non-facility) one.

$98.56–$150.88 across payment localities · Office (non-facility)

Participating physician · Before sequestration

CMS evidence · Q2 2025 release

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The national PFS baseline was $111.60 for CPT 76018 in the Office (non-facility) setting and $111.60 in a facility under the Q2 2025 Physician Fee Schedule, effective April 2025. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $111.60 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Arbitration outcomes for 76018 are coming Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $111.60 Office (non-facility) allowed amount: Medicare pays $87.49 after sequestration and the patient owes $22.32, once the Part B deductible is met.

Adjust for your locality →
76018: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $111.60 $87.49 $89.28 − $1.79 $22.32 $106.02 $121.92

National Q2 2025, GPCI 1.000. Each % applies before the 80/20 split and sequestration.

Is $111.60 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($89.28) and the patient owes 20% coinsurance ($22.32). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 76018?

$106.02 in the Office (non-facility) setting—95% of the $111.60 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 76018?

$121.92 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $111.60 amount above. The non-participating amount is 95% of the fee schedule rate ($106.02), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU25BApril 1 – June 30, 2025 See file rows

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 76018: PCTC 1 (splits into professional and technical) · MULT PROC 4 (special imaging rules apply).

Professional/technical split

Splits into professional and technical

PCTC

1

This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.

76018 billed whole or split (-26 and -TC), national amounts by setting
Billed as Office (non-facility) Facility
76018 $111.60 $111.60
76018-26 $33.96 $33.96
76018-TC $77.63 $77.63

The components sum to $111.59 in the office, not the $111.60 whole amount; CMS prices each line separately, so bill from the line you report.

Multiple procedures

Special imaging rules apply

MULT PROC

4

This procedure is subject to the diagnostic-imaging multiple-procedure reduction rather than the standard rule.

-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.

Global surgery period XXX (does not apply). Assistant at surgery, only if documented: -80/81/82 $17.86 · -AS $15.18. Not payable with 76018: -50 · -62 · -66.

Modifier amounts are derived, not a CMS column: Localis applies the standard MPFS percentage to the national Office (non-facility) amount. Check them against the Claims Processing Manual. If documented means paid only when documentation of medical necessity is submitted. Locality-adjusted amounts.

Why would a Medicare claim for 76018 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CMS RVU25BApril 1 – June 30, 2025 See file rows

Can you bill it with another code? Copy link

This code

76018

See every current NCCI pair for 76018 →

Payment review for 76018 Copy link

Checking a paid 76018 line?

Check an actual payment Model this code in a contract
What to check (4)

Three published payment rules can change what 76018 allows on a claim: the professional/technical split, the diagnostic-imaging reduction and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

  • Confirm which component the line carried before comparing anything: the same code prices three ways—globally, as a professional component with modifier 26, and as a technical component with modifier TC.
  • Check for a second imaging line on the same date: the technical component of the lower-ranked one is reduced by rule, which accounts for a shortfall that looks like a payer error.
  • Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Claims Processing Manual (Pub. 100-04); CMS Transmittal R694OTN: MPPR on the Technical Component of Certain Diagnostic Imaging Procedures; 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

How location and RVUs set the amount Copy link

Office (non-facility) and facility: 3.45 RVUs × $32.3465 = $111.60 national PFS baseline. Local GPCIs move it from $98.56 in Mississippi, MS to $150.88 in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.

Office (non-facility) and facility

Office (non-facility) and facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 0.75 1.000 0.75
Practice expense 2.66 1.000 2.66
Malpractice 0.04 1.000 0.04
Total RVUs 3.45
× Conversion factor $32.3465
= National PFS baseline $111.60

Rates by locality Copy link

Maine: $103.66–$112.18 across 2 localities ME Wisconsin: $107.03 WI Vermont: $110.37 VT New Hampshire: $114.39 NH Montana: $111.57 MT North Dakota: $110.97 ND Minnesota: $112.84 MN Michigan: $104.16–$111.39 across 2 localities MI New York: $106.86–$131.56 across 5 localities NY Massachusetts: $116.99–$129.43 across 2 localities MA Rhode Island: $115.36 RI Washington: $114.95–$131.38 across 2 localities WA Idaho: $102.98 ID Wyoming: $111.26 WY South Dakota: $110.80 SD Iowa: $103.41 IA Illinois: $104.52–$116.61 across 4 localities IL Indiana: $104.22 IN Ohio: $103.98 OH Pennsylvania: $105.22–$116.97 across 2 localities PA New Jersey: $121.82–$127.99 across 2 localities NJ Connecticut: $120.23 CT Oregon: $109.93–$120.37 across 2 localities OR Nevada: $111.39 NV Utah: $105.74 UT Colorado: $116.13 CO Nebraska: $103.55 NE Missouri: $99.43–$107.46 across 3 localities MO Kentucky: $100.90 KY West Virginia: $100.15 WV Virginia: $109.95 VA Maryland: $113.23–$119.19 across 2 localities MD Delaware: $111.06 DE California: $119.37–$150.88 across 29 localities CA Arizona: $109.26 AZ New Mexico: $103.90 NM Kansas: $102.91 KS Oklahoma: $101.97 OK Arkansas: $98.93 AR Tennessee: $102.06 TN North Carolina: $104.79 NC South Carolina: $103.87 SC District of Columbia: $129.72 DC Texas: $103.18–$115.44 across 8 localities TX Louisiana: $101.33–$106.20 across 2 localities LA Mississippi: $98.56 MS Alabama: $99.77 AL Georgia: $101.69–$111.50 across 2 localities GA Florida: $107.04–$115.86 across 3 localities FL Alaska: $130.17 AK Hawaii: $123.85 HI
$99–$104 $104–$109 $109–$114 $114–$120 $120–$125 $125–$130

76018 Office (non-facility) by metro, highest first

San Jose, CA $150.70 Locality 01112-09 San Francisco, CA $149.06 Locality 01112-05 Long Island, NY $131.56 Locality 13202-02 Seattle, WA $131.38 Locality 02402-02 Queens, NY $130.55 Locality 13292-04 Anchorage, AK $130.17 Locality 02102-01
Show 56 more metros
Washington, DC $129.72 Locality 12202-01 Boston, MA $129.43 Locality 14212-01 Los Angeles, CA $128.91 Locality 01182-18 New York City, NY $128.30 Locality 13202-01 San Diego, CA $128.15 Locality 01182-72 Northern New Jersey, NJ $127.99 Locality 12402-01 Ventura County, CA $127.52 Locality 01182-17 Sacramento, CA $125.27 Locality 01112-63 Honolulu, HI $123.85 Locality 01212-01 Portland, OR $120.37 Locality 02302-01 Hartford, CT $120.23 Locality 13102-00 Riverside, CA $119.80 Locality 01112-62 Bakersfield, CA $119.57 Locality 01112-54 Fresno, CA $119.37 Locality 01112-56 Baltimore, MD $119.19 Locality 12302-01 Philadelphia, PA $116.97 Locality 12502-01 Suburban Chicago, IL $116.61 Locality 06102-15 Denver, CO $116.13 Locality 04112-01 Miami, FL $115.86 Locality 09102-04 Austin, TX $115.44 Locality 04412-31 Providence, RI $115.36 Locality 14412-01 Chicago, IL $115.06 Locality 06102-16 Minneapolis, MN $112.84 Locality 06202-00 Houston, TX $112.72 Locality 04412-18 Fort Lauderdale, FL $112.42 Locality 09102-03 Dallas, TX $112.31 Locality 04412-11 Portland, ME $112.18 Locality 14112-03 Fort Worth, TX $111.56 Locality 04412-28 Atlanta, GA $111.50 Locality 10212-01 Detroit, MI $111.39 Locality 08202-01 Las Vegas, NV $111.39 Locality 01312-00 Richmond, VA $109.95 Locality 11302-00 Phoenix, AZ $109.26 Locality 03102-00 St. Louis, MO $107.46 Locality 05302-01 Kansas City, MO $107.11 Locality 05302-02 Tampa, FL $107.04 Locality 09102-99 Milwaukee, WI $107.03 Locality 06302-00 Buffalo, NY $106.86 Locality 13282-99 San Antonio, TX $106.78 Locality 04412-99 New Orleans, LA $106.20 Locality 07202-01 Salt Lake City, UT $105.74 Locality 03502-09 Metro East, IL $105.55 Locality 06102-12 Pittsburgh, PA $105.22 Locality 12502-99 Charlotte, NC $104.79 Locality 11502-00 Indianapolis, IN $104.22 Locality 08102-00 Columbus, OH $103.98 Locality 15202-00 Albuquerque, NM $103.90 Locality 04212-05 Charleston, SC $103.87 Locality 11202-01 Omaha, NE $103.55 Locality 05402-00 Des Moines, IA $103.41 Locality 05102-00 Boise, ID $102.98 Locality 02202-00 Wichita, KS $102.91 Locality 05202-00 Nashville, TN $102.06 Locality 10312-35 Oklahoma City, OK $101.97 Locality 04312-00 Louisville, KY $100.90 Locality 15102-00 Birmingham, AL $99.77 Locality 10112-00
Maine: $103.66–$112.18 across 2 localities ME Wisconsin: $107.03 WI Vermont: $110.37 VT New Hampshire: $114.39 NH Montana: $111.57 MT North Dakota: $110.97 ND Minnesota: $112.84 MN Michigan: $104.16–$111.39 across 2 localities MI New York: $106.86–$131.56 across 5 localities NY Massachusetts: $116.99–$129.43 across 2 localities MA Rhode Island: $115.36 RI Washington: $114.95–$131.38 across 2 localities WA Idaho: $102.98 ID Wyoming: $111.26 WY South Dakota: $110.80 SD Iowa: $103.41 IA Illinois: $104.52–$116.61 across 4 localities IL Indiana: $104.22 IN Ohio: $103.98 OH Pennsylvania: $105.22–$116.97 across 2 localities PA New Jersey: $121.82–$127.99 across 2 localities NJ Connecticut: $120.23 CT Oregon: $109.93–$120.37 across 2 localities OR Nevada: $111.39 NV Utah: $105.74 UT Colorado: $116.13 CO Nebraska: $103.55 NE Missouri: $99.43–$107.46 across 3 localities MO Kentucky: $100.90 KY West Virginia: $100.15 WV Virginia: $109.95 VA Maryland: $113.23–$119.19 across 2 localities MD Delaware: $111.06 DE California: $119.37–$150.88 across 29 localities CA Arizona: $109.26 AZ New Mexico: $103.90 NM Kansas: $102.91 KS Oklahoma: $101.97 OK Arkansas: $98.93 AR Tennessee: $102.06 TN North Carolina: $104.79 NC South Carolina: $103.87 SC District of Columbia: $129.72 DC Texas: $103.18–$115.44 across 8 localities TX Louisiana: $101.33–$106.20 across 2 localities LA Mississippi: $98.56 MS Alabama: $99.77 AL Georgia: $101.69–$111.50 across 2 localities GA Florida: $107.04–$115.86 across 3 localities FL Alaska: $130.17 AK Hawaii: $123.85 HI
$99–$104 $104–$109 $109–$114 $114–$120 $120–$125 $125–$130

76018 Facility by metro, highest first

San Jose, CA $150.70 Locality 01112-09 San Francisco, CA $149.06 Locality 01112-05 Long Island, NY $131.56 Locality 13202-02 Seattle, WA $131.38 Locality 02402-02 Queens, NY $130.55 Locality 13292-04 Anchorage, AK $130.17 Locality 02102-01
Show 56 more metros
Washington, DC $129.72 Locality 12202-01 Boston, MA $129.43 Locality 14212-01 Los Angeles, CA $128.91 Locality 01182-18 New York City, NY $128.30 Locality 13202-01 San Diego, CA $128.15 Locality 01182-72 Northern New Jersey, NJ $127.99 Locality 12402-01 Ventura County, CA $127.52 Locality 01182-17 Sacramento, CA $125.27 Locality 01112-63 Honolulu, HI $123.85 Locality 01212-01 Portland, OR $120.37 Locality 02302-01 Hartford, CT $120.23 Locality 13102-00 Riverside, CA $119.80 Locality 01112-62 Bakersfield, CA $119.57 Locality 01112-54 Fresno, CA $119.37 Locality 01112-56 Baltimore, MD $119.19 Locality 12302-01 Philadelphia, PA $116.97 Locality 12502-01 Suburban Chicago, IL $116.61 Locality 06102-15 Denver, CO $116.13 Locality 04112-01 Miami, FL $115.86 Locality 09102-04 Austin, TX $115.44 Locality 04412-31 Providence, RI $115.36 Locality 14412-01 Chicago, IL $115.06 Locality 06102-16 Minneapolis, MN $112.84 Locality 06202-00 Houston, TX $112.72 Locality 04412-18 Fort Lauderdale, FL $112.42 Locality 09102-03 Dallas, TX $112.31 Locality 04412-11 Portland, ME $112.18 Locality 14112-03 Fort Worth, TX $111.56 Locality 04412-28 Atlanta, GA $111.50 Locality 10212-01 Detroit, MI $111.39 Locality 08202-01 Las Vegas, NV $111.39 Locality 01312-00 Richmond, VA $109.95 Locality 11302-00 Phoenix, AZ $109.26 Locality 03102-00 St. Louis, MO $107.46 Locality 05302-01 Kansas City, MO $107.11 Locality 05302-02 Tampa, FL $107.04 Locality 09102-99 Milwaukee, WI $107.03 Locality 06302-00 Buffalo, NY $106.86 Locality 13282-99 San Antonio, TX $106.78 Locality 04412-99 New Orleans, LA $106.20 Locality 07202-01 Salt Lake City, UT $105.74 Locality 03502-09 Metro East, IL $105.55 Locality 06102-12 Pittsburgh, PA $105.22 Locality 12502-99 Charlotte, NC $104.79 Locality 11502-00 Indianapolis, IN $104.22 Locality 08102-00 Columbus, OH $103.98 Locality 15202-00 Albuquerque, NM $103.90 Locality 04212-05 Charleston, SC $103.87 Locality 11202-01 Omaha, NE $103.55 Locality 05402-00 Des Moines, IA $103.41 Locality 05102-00 Boise, ID $102.98 Locality 02202-00 Wichita, KS $102.91 Locality 05202-00 Nashville, TN $102.06 Locality 10312-35 Oklahoma City, OK $101.97 Locality 04312-00 Louisville, KY $100.90 Locality 15102-00 Birmingham, AL $99.77 Locality 10112-00

Q2 2025, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU25BApril 1 – June 30, 2025 See file rows

Source & method Copy link

  1. 01 PPRRVU25_APR.csv · Q2 2025 (RVU25B) · row 14,443—status A, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q2 2025 release
    Effective
    April 1 – June 30, 2025
    Locator
    PPRRVU25_APR.csv in rvu25b-updated-06-05-2025.zip · row 14,443 of 18,923 · via CMS
    Fields read
    Status A (col 4) Work RVU 0.75 (col 6) Office (non-facility) PE RVU 2.66 (col 7) Facility PE RVU 2.66 (col 9) Malpractice RVU 0.04 (col 11)
    SHA-256 c793cc01a477feb3…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 14,443 · column 25—$32.3465
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 Derived Modifier amounts—calculated by Localis from standard MPFS percentages limits
    Source
    Modifier amounts apply standard MPFS percentages to this code’s billing indicators.
    Doesn’t establish
    A CMS-published amount: we derive these rather than read them from CMS. Confirm them against the current Claims Processing Manual before relying on them for payment.

Cite this rate

CPT 76018 National PFS baseline: Office (non-facility) $111.60; Facility $111.60 (Q2 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25B, PPRRVU25_APR.csv row 14,443. Localis. https://localishealth.com/cpt/76018/2025/B

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

How has it changed? Copy link

$114.90 Office (non-facility) and $114.90 Facility since Jan 1, 2026, after a +3.0% increase in the Office (non-facility) amount.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $114.90 (+$3.30, +3.0% increase)
    Facility
    $114.90 (+$3.30, +3.0% increase)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $111.60
    Facility
    $111.60

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

    Earliest release in this history.

National baseline (GPCI 1.000), before sequestration.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 76018 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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