Guide

The MPFS lookup: your rate, your locality, the current year

Summary

To see what Medicare pays for a code, use CMS's Physician Fee Schedule Search. Enter the CPT or HCPCS code, choose the year and your locality, and it returns the national and locality payment amount, the relative value units behind it, and the payment status indicators — including whether the code is bundled, separately payable, or non-covered. The conversion factor and the values update every year, so always check the current year.

By Gale Editorial · Updated 2026-07-26. Every figure cited to a dated source. How we write.

How do I look up what Medicare pays for a code?

Use CMS's Physician Fee Schedule Search, the free public tool built for exactly this question. Enter the CPT or HCPCS code, choose the year and your locality, and it returns the national and locality-adjusted payment amount, the relative value units behind the code, and its payment and status indicators 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code.. That figure is the authoritative Medicare amount — not an estimate, not a vendor's number.

The fee schedule sets payment for clinician services and is republished every year through rulemaking, which changes the conversion factor, the values, and sometimes the policy attached to a code 2Ref 2Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule.That the Medicare Physician Fee Schedule sets payment for clinician services and is updated annually through rulemaking — the conversion factor, the RVUs, and policy — which is why a prior year's amount is not reliably the current one.. That annual cadence is why the single most common lookup error is reading a prior year's amount. Set the year first, every time, before you trust the number on the screen.

The five inputs that change the number

One code does not have one price. The amount the tool returns depends on five inputs, and changing any of them changes the answer: the code itself, the payment year, your locality, whether the service is performed in a facility or non-facility setting, and any modifiers that adjust the service. Miss one and you can quote a rate that is real but not yours 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code..

The two that trip people most are locality and setting, because they are easy to leave on a default. A solo clinician looking up a routine office code wants the non-facility amount for their own locality, not the national average shown as a starting point. Build the whole address into the lookup — your fee schedule should be built from your locality's numbers, not the national ones.

Why the same code pays differently in two ZIP codes

Medicare adjusts each code's payment by locality, so the identical service pays a different amount in two different regions. The lookup applies that geographic adjustment when you select your locality 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code., and your locality follows your jurisdiction — which is administered by your Medicare contractor, the same one that tells you which MAC processes my Medicare claims is the question to answer when you're unsure 3Ref 3Centers for Medicare & Medicaid Services (2026).Medicare Administrative Contractors.That Medicare claims administration is regionalized across MACs and that CMS publishes which MAC serves each jurisdiction, which is how a provider identifies the locality and contractor their payment is tied to..

Underneath the locality adjustment sit the relative value units, the building blocks that weight a code for the work, practice expense, and liability it represents before any dollar figure is applied. You don't need to compute RVUs by hand to use the lookup, but understanding fee-schedules and how RVUs drive them explains why a long, complex service outpays a brief one by more than time alone would suggest.

Facility vs non-facility: two amounts for one code

Most codes return two payment amounts, and choosing the wrong one is a quiet, recurring error. The facility rate applies when the service is done in a place like a hospital that carries its own overhead; the non-facility rate, usually higher, applies in your own office because you bear the practice-expense cost yourself 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code.. The tool shows both side by side.

For a solo practice seeing patients in its own space, the non-facility amount is almost always the right column — but confirm it per service rather than assuming. The facility vs non-facility differential is a site-of-service question, and a clinician who splits time between an office and a facility bills the same code at two different rates depending on where the work happened. The setting is a billing fact, not a rounding detail.

The conversion factor, and why last year's number is wrong

Medicare turns a code's relative value units into dollars by multiplying them by a single national conversion factor, and that factor is reset every year through rulemaking along with the values themselves 2Ref 2Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule.That the Medicare Physician Fee Schedule sets payment for clinician services and is updated annually through rulemaking — the conversion factor, the RVUs, and policy — which is why a prior year's amount is not reliably the current one.. A number that was correct in one year is not reliably correct in the next, even if the code and your locality never changed. This is the mechanism behind "the fee schedule went down" headlines.

The operational consequence is small but strict: re-pull your Medicare rates when the new year's fee schedule takes effect, and re-derive anything you built on top of them. If your charges or your expectations are pegged to Medicare, an annual refresh keeps them from drifting away from what actually pays.

Reading the status indicators

The payment and status indicators are the part of the lookup people skip and shouldn't. They tell you whether a code is separately payable, bundled into another service, carrier-priced, or not covered at all — which is the difference between a code that will pay on its own and one that will silently deny or absorb into a companion service 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code.. A rate next to a "bundled" status is not a rate you will collect separately.

One status question the fee schedule alone won't fully answer is telehealth: whether a given code is payable when delivered by telehealth has its own annual list, which also marks audio-only eligibility and permanent-versus-temporary status 4Ref 4Centers for Medicare & Medicaid Services (2026).List of Telehealth Services.That CMS publishes a definitive annual list of codes payable as Medicare telehealth, including audio-only eligibility and permanent-versus-temporary status — the separate check for whether a code is payable when delivered by telehealth. As of July 2026.. If you deliver a service remotely, check that list in addition to the fee schedule before you count on the payment.

What the lookup doesn't tell you

The fee schedule answers a narrow question — what Medicare pays this code, in your locality, this year — and it is easy to over-read. It is not your commercial rate; private payers negotiate their own amounts, and many practices set their charges as a multiple, pricing off Medicare rather than copying it. It also won't price a service Medicare doesn't cover, so you won't find no-show fees there, because a missed appointment isn't a covered service.

Two Medicare-specific adjustments also sit outside the base number. For eligible clinicians, a MIPS payment adjustment can raise or lower Part B payment on top of the fee schedule, though clinicians under the low-volume threshold are excluded entirely 5Ref 5Centers for Medicare & Medicaid Services (2026).MIPS Overview.That MIPS applies a payment adjustment to Medicare Part B payment for eligible clinicians on top of the fee schedule, and that clinicians under the low-volume threshold are excluded. As of July 2026.. And when Medicare is the secondary payer, coordination of benefits determines how much actually comes to you after the primary pays 6Ref 6Centers for Medicare & Medicaid Services (2026).Coordination of Benefits and Recovery Overview.That coordination of benefits determines primary-versus-secondary payer order, so when Medicare is secondary the fee-schedule amount is not the full picture of what a provider collects.. One practical guardrail sits under all of it: billing below the allowable leaves money uncollected and can create its own compliance problems, so don't set a charge beneath what the schedule allows.

A repeatable lookup

Run the same short sequence every time and the number you quote will be the number that pays. Each step corresponds to one of the inputs the tool actually uses.

Open the Physician Fee Schedule Search and set the current payment year first 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code..
Enter the exact CPT or HCPCS code, including any modifier that changes the service 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code..
Select your locality, not the national default, so the geographic adjustment applies 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code..
Read the non-facility amount for office work, or the facility amount when the service was done elsewhere 1Ref 1Centers for Medicare & Medicaid Services (2026).Physician Fee Schedule Search.That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code..
Check the status indicator before relying on the rate, and confirm telehealth eligibility separately if the service was remote 4Ref 4Centers for Medicare & Medicaid Services (2026).List of Telehealth Services.That CMS publishes a definitive annual list of codes payable as Medicare telehealth, including audio-only eligibility and permanent-versus-temporary status — the separate check for whether a code is payable when delivered by telehealth. As of July 2026..

Common questions

CMS publishes the Physician Fee Schedule Search, a free public tool that returns the payment amount, relative value units, and status indicators for any CPT or HCPCS code. It is the authoritative source for what Medicare pays a code, by locality and payment year, rather than a third-party estimate.

Those are the facility and non-facility rates. The non-facility amount, usually higher, applies when you perform the service in your own office and bear the overhead; the facility amount applies when the service is done somewhere like a hospital. A solo office practice generally uses the non-facility column, confirmed per service.

Because the fee schedule is reset annually through rulemaking. The conversion factor that turns relative value units into dollars, and the values themselves, are updated each year, so the same code and locality can pay a different amount. Re-pull your rates when the new year's schedule takes effect.

No. The lookup shows the base fee-schedule amount. For eligible clinicians, a MIPS payment adjustment is applied on top of that and can move Part B payment up or down. Clinicians under the low-volume threshold are excluded from MIPS, so no adjustment applies to them.

Many practices do use it as an anchor, setting charges as a multiple of the Medicare allowable, but the fee schedule only reflects Medicare. Commercial payers negotiate separate rates, and Medicare doesn't price non-covered services like missed-appointment fees, so treat the lookup as a reference point, not a full fee schedule.

Run your practice on Gale

The software is free. Gale earns one flat 3.5% all-in per paid transaction — only on transactions that actually pay. No subscription, no setup fee, no network cut.

Start or manage a practice →

References

1.Centers for Medicare & Medicaid Services (2026). Physician Fee Schedule Search. Centers for Medicare & Medicaid Services (CMS). link ✓That CMS publishes a public Physician Fee Schedule look-up tool returning the national and locality payment amount, the RVUs, and the payment and status indicators for a CPT/HCPCS code, including the facility and non-facility amounts — the lookup method for what Medicare pays a code.
2.Centers for Medicare & Medicaid Services (2026). Physician Fee Schedule. Centers for Medicare & Medicaid Services (CMS). link ✓That the Medicare Physician Fee Schedule sets payment for clinician services and is updated annually through rulemaking — the conversion factor, the RVUs, and policy — which is why a prior year's amount is not reliably the current one.
3.Centers for Medicare & Medicaid Services (2026). Medicare Administrative Contractors. Centers for Medicare & Medicaid Services (CMS). link ✓That Medicare claims administration is regionalized across MACs and that CMS publishes which MAC serves each jurisdiction, which is how a provider identifies the locality and contractor their payment is tied to.
4.Centers for Medicare & Medicaid Services (2026). List of Telehealth Services. Centers for Medicare & Medicaid Services (CMS). link ✓That CMS publishes a definitive annual list of codes payable as Medicare telehealth, including audio-only eligibility and permanent-versus-temporary status — the separate check for whether a code is payable when delivered by telehealth. As of July 2026.
5.Centers for Medicare & Medicaid Services (2026). MIPS Overview. CMS Quality Payment Program. link ✓That MIPS applies a payment adjustment to Medicare Part B payment for eligible clinicians on top of the fee schedule, and that clinicians under the low-volume threshold are excluded. As of July 2026.
6.Centers for Medicare & Medicaid Services (2026). Coordination of Benefits and Recovery Overview. Centers for Medicare & Medicaid Services (CMS). link ✓That coordination of benefits determines primary-versus-secondary payer order, so when Medicare is secondary the fee-schedule amount is not the full picture of what a provider collects.

https://www.gale.care/for-providers/mc-mpfs-lookup · 6 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

← Back to for providers