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

Automatically picks the release in effect.

Release

Override only when checking an older adjudication.

Locality

Choose where the service was performed.

No results found

National (GPCI 1.000)

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

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.

G9983 pays $28.40 more at non-facility (office) than facility

Billing the wrong place of service is a common, fixable underpayment. Non-facility $52.11 Facility $23.71

G9983 2026 C · National (GPCI 1.000) · Office (non-facility) · status A (Active)

Medicare calculates a national payment amount for this code and pays it separately when the service is covered.

Medicare pays

$40.86

Total expected to provider

$51.28

Allowed amount: $52.11
Medicare portion (80%): $41.69
Sequestration (−2%): −$0.83
Medicare pays: $40.86
Patient / secondary (20%): $10.42
Total expected to provider: $51.28

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	0.48	1.000	0.480
Practice expense (non-facility)	1.02	1.000	1.020
Malpractice	0.06	1.000	0.060
× conversion factor $33.4009 = allowed			$52.11

G9983 — 2026 C · National (GPCI 1.000) · Office (non-facility)
Allowed amount: $52.11
Medicare pays: $40.86
Patient / secondary (20%): $10.42
Total expected to provider: $51.28

Allowed = locality-adjusted, before sequestration. Sequestration applies to the Medicare 80% portion. See the full G9983 page and how Medicare pays.

Get this by API Live

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. Keys are free and self-serve.

Get an API key

curl -X POST -H "Authorization: Bearer $API_KEY" \
  -H "Content-Type: application/json" \
  -d '{"codes":["G9983"],"setting":"non_facility","year":2026,"quarter":"C","sequestration":true}' \
  "https://localishealth.com/v1/rates/bulk"

Returns the national amount (GPCI 1.000). Add "locality" to the request body for a locality-adjusted rate — the calculator has a searchable locality picker. The same rate stays on this page free with no account — read the full reference.

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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