What does Medicare pay for this code?
Pick a CPT code and a state. See the 2026 Physician Fee Schedule payment for both facility and non-facility settings, with the national average for comparison.
Why does Medicare pay different amounts in different places?
Geographic Practice Cost Index
Medicare adjusts each RVU component by GPCI: physician work, practice expense, and malpractice. High cost-of-living areas like California and New York pay more; rural states pay less.
Facility vs non-facility
When the service is performed in a facility (hospital, ASC), part of the practice expense is paid to the facility instead of the physician, so the physician fee is lower.
Conversion factor
The CMS Conversion Factor is set annually and applies nationally. The 2026 factor multiplies your locality-adjusted RVUs to produce the dollar payment.
Knowing the Medicare rate is one thing. Knowing if you got paid it is another.
Commercial payers underpay against contracted rates more often than billers catch. Stale fee schedules, downcoded line items, and silent contractual adjustments quietly drain revenue every month. We audit your last 90 days of remits, find the underpayments, and pursue them. No obligation.
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