When it is applied Copy link
The sequestration reduction is applied at the end of the calculation, after RVUs, GPCIs, and the conversion factor have produced a payment amount. Because it is the last step, the gross amount and the net amount differ only by the reduction percentage.
Why we keep it optional Copy link
Some readers need the gross fee schedule amount for contract benchmarking; others need the net amount that will actually be paid. We apply sequestration only when you ask for it and never build it into the underlying rate, so both figures stay available.
The rate can change Copy link
Congress has changed the sequestration percentage over time, including temporary suspensions and phase-ins. Because we apply it as a separate last step, those changes never touch the underlying rate. Only the optional net figure moves.
Sequestration calculator Copy link
Enter the allowed amount to see the reduction as it appears on a remittance. For a $100.00 allowed amount with the deductible met: Medicare's share is $80.00, a 2% sequestration reduction takes $1.60, so Medicare pays $78.40; the patient or secondary payer still owes the full $20.00 coinsurance, for a total expected collection of $98.40.
- Medicare share (80%)
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- Reduction
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- Medicare pays
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- Patient / secondary (20%)
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Assumes the Part B deductible is met and no other adjustments apply.
Frequently asked Copy link
Is sequestration included in the rate you show?
Not by default. We show the gross fee schedule amount and apply the ~2% reduction only when you ask for the net figure.
Is sequestration always exactly 2%?
It is usually about 2%, but Congress has changed the percentage over time. We apply it as a final step, so the base rate is not affected.
Sources Copy link
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
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