Medicare payment calculator by CPT code

Check one claim line by code, date, locality, and setting. See the expected Medicare payment, patient share, sequestration, and variance against the remittance.

Only have an RVU figure? Convert RVUs to dollars.

Why place of service matters

$12,266/ year

Potential gap for 20 monthly 99214 visits billed at the wrong setting.

See the worked example

In the Q3 2026 release, 99214's national non-facility amount is $135.61 versus $84.50 in a facility—a $51.11 gap per visit before locality adjustment. Annual impact assumes 20 visits a month for 12 months; it is an example volume, not a claims count.

Claim details

Enter what was billed, when, and where. The expected payment updates below.

HCPCS / CPT code

Date of service

Selects the MAC schedule effective on the claim date.

Release

Override only when checking an older adjudication.

Locality

Required: MAC amounts are local, never national.

No results found

Select a locality

00 — Alabama (AL)

01 — Alaska* (AK)

00 — Arizona (AZ)

13 — Arkansas (AR)

01 — Atlanta (GA)

31 — Austin (TX)

54 — Bakersfield (CA)

01 — Baltimore/Surr. Counties (MD)

20 — Beaumont (TX)

09 — Brazoria (TX)

16 — Chicago (IL)

55 — Chico (CA)

01 — Colorado (CO)

00 — Connecticut (CT)

11 — Dallas (TX)

01 — Dc + Md/Va Suburbs (DC)

01 — Delaware (DE)

01 — Detroit (MI)

12 — East St. Louis (IL)

71 — El Centro (CA)

03 — Fort Lauderdale (FL)

28 — Fort Worth (TX)

56 — Fresno (CA)

15 — Galveston (TX)

57 — Hanford-Corcoran (CA)

01 — Hawaii, Guam (HI)

18 — Houston (TX)

00 — Idaho (ID)

00 — Indiana (IN)

00 — Iowa (IA)

00 — Kansas (KS)

00 — Kentucky (KY)

18 — Los Angeles-Long Beach-Anaheim (Los Angeles/Orange County) (CA)

58 — Madera (CA)

01 — Manhattan (NY)

59 — Merced (CA)

01 — Metropolitan Boston (MA)

02 — Metropolitan Kansas City (MO)

01 — Metropolitan Philadelphia (PA)

01 — Metropolitan St. Louis (MO)

04 — Miami (FL)

00 — Minnesota (MN)

00 — Mississippi (MS)

60 — Modesto (CA)

01 — Montana** (MT)

51 — Napa (CA)

00 — Nebraska (NE)

00 — Nevada** (NV)

40 — New Hampshire (NH)

05 — New Mexico (NM)

01 — New Orleans (LA)

00 — North Carolina (NC)

01 — North Dakota** (ND)

01 — Northern Nj (NJ)

02 — NYC Suburbs/Long Island (NY)

00 — Ohio (OH)

00 — Oklahoma (OK)

17 — Oxnard-Thousand Oaks-Ventura (CA)

01 — Portland (OR)

03 — Poughkpsie/N NYC Suburbs (NY)

20 — Puerto Rico (PR)

04 — Queens (NY)

61 — Redding (CA)

75 — Rest of California (CA)

99 — Rest of Florida (FL)

99 — Rest of Georgia (GA)

99 — Rest of Illinois (IL)

99 — Rest of Louisiana (LA)

99 — Rest of Maine (ME)

99 — Rest of Maryland (MD)

99 — Rest of Massachusetts (MA)

99 — Rest of Michigan (MI)

99 — Rest of Missouri (MO)

99 — Rest of New Jersey (NJ)

99 — Rest of New York (NY)

99 — Rest of Oregon (OR)

99 — Rest of Pennsylvania (PA)

99 — Rest of Texas (TX)

99 — Rest of Washington (WA)

01 — Rhode Island (RI)

62 — Riverside-San Bernardino-Ontario (CA)

63 — Sacramento-Roseville-Folsom (CA)

64 — Salinas (CA)

72 — San Diego-Chula Vista-Carlsbad (CA)

52 — San Francisco-Oakland-Berkeley (Marin County) (CA)

05 — San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County) (CA)

65 — San Jose-Sunnyvale-Santa Clara (San Benito County) (CA)

09 — San Jose-Sunnyvale-Santa Clara (Santa Clara County) (CA)

73 — San Luis Obispo-Paso Robles (CA)

66 — Santa Cruz-Watsonville (CA)

74 — Santa Maria-Santa Barbara (CA)

67 — Santa Rosa-Petaluma (CA)

02 — Seattle (King County) (WA)

01 — South Carolina (SC)

02 — South Dakota** (SD)

03 — Southern Maine (ME)

68 — Stockton (CA)

15 — Suburban Chicago (IL)

35 — Tennessee (TN)

09 — Utah (UT)

53 — Vallejo (CA)

50 — Vermont (VT)

00 — Virginia (VA)

50 — Virgin Islands (VI)

69 — Visalia (CA)

16 — West Virginia (WV)

00 — Wisconsin (WI)

21 — Wyoming** (WY)

70 — Yuba City (CA)

Place of service

Provider participation

Select the published amount that applies.

Modifier (optional)

Single-line modifiers only — -51 (multiple-procedure reduction) needs a full claim and isn't priced here.

Apply sequestration (−2% of Medicare's portion)

% of Medicare

For commercial contracts priced off Medicare (e.g. 115%).

Actual Medicare paid (optional)

Enter what the payer actually paid to see the variance.

No expected amount for 37799

Carrier-priced codes require a specific Medicare locality. Select one below; there is no national MAC amount. Release 2026 C · status C (Carrier-priced)

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

This is a single-line calculator, and it's free. Batch reconciliation — a remittance or a CSV of claims checked for underpayments across a whole book — isn't built yet; it's where we're headed. See the plan.

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