Medicare payment calculator by CPT code
A practice billing 20 99214 visits a month at the wrong place of service — office instead of facility — loses about $12,266 a year. In the Q3 2026 release, 99214's national non-facility allowed amount is $135.61; billed as facility instead, it's $84.50 — a $51.11 gap per visit before any locality adjustment, times 20 visits/month (an assumed volume, not a claims count) times 12 months.
That's the kind of error this calculator catches on a single claim. Enter a code, date of service, locality, and setting to see the expected Medicare allowed amount, the 80/20 split, sequestration, and — if you enter what the payer actually paid — the variance. Only have an RVU figure? Convert RVUs to dollars.
- Allowed amount
- $1,534.10
- Medicare portion (80%)
- $1,227.28
- Sequestration (−2%)
- −$24.55
- Medicare pays
- $1,202.73
- Patient / secondary (20%)
- $306.82
- Total expected to provider
- $1,509.55
How this amount is computed
allowed = (work·RVU × work·GPCI + PE·RVU × PE·GPCI + MP·RVU × MP·GPCI) × conversion factor, using the non-facility practice-expense column.
| Component | RVU | GPCI | Subtotal |
|---|---|---|---|
| Work | 28.84 | 1.000 | 28.840 |
| Practice expense (non-facility) | 9.81 | 1.000 | 9.810 |
| Malpractice | 7.28 | 1.000 | 7.280 |
| × conversion factor $33.4009 = allowed | $1,534.10 | ||
33641 — 2026 C · National (GPCI 1.000) · Office (non-facility) Allowed amount: $1,534.10 Medicare pays: $1,202.73 Patient / secondary (20%): $306.82 Total expected to provider: $1,509.55
Allowed = locality-adjusted, before sequestration. Sequestration applies to the Medicare 80% portion. See the full 33641 page and how Medicare pays.
The API we're building Not live yet
The same number, programmatically — the bulk endpoint returns the payable amount, status, the release that answered it, and full citations (CMS file, row, and the math) for every code in one call. This is the shape it will ship in; keys aren't open yet.
curl -X POST -H "Authorization: Bearer $API_KEY" \
-H "Content-Type: application/json" \
-d '{"codes":["33641"],"setting":"non_facility","year":2026,"quarter":"C","sequestration":true}' \
"https://localishealth.com/v1/rates/bulk""locality"
to the request body for a locality-adjusted rate — the calculator has a searchable locality picker.
The same rate is on this page today, free — tell us what you'd automate with it.
This is a single-line calculator, and it's free. Batch reconciliation (upload a remittance or a CSV of claims to flag underpayments across a whole book), modifier-adjusted pricing, and API access aren't built yet — they're what we're working toward. See the plan.
Did this answer your question about this calculator?
We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.