Free Medicare Billing Tool

Medicare Fee Schedule Calculator

Estimate a Medicare Physician Fee Schedule payment using Work, Practice Expense and Malpractice RVUs, geographic practice cost indices (GPCIs), and the applicable conversion factor.

2026 calculator: CMS finalized separate CY 2026 conversion factors of $33.40 for non-QP clinicians and $33.57 for qualifying APM participants (QPs). This calculator lets you change the conversion factor when needed.

Enter PFS values

Use RVU and GPCI values from the CMS PFS Look-Up Tool or the applicable official CMS/MAC file.

1. Service & payment setting

CPT / HCPCS code (optional)

Place-of-service pricing Non-Facility Facility

2026 conversion factor Non-QP — $33.40 Qualifying APM Participant (QP) — $33.57 Custom conversion factor

Use the QP rate only when the clinician qualifies for the statutory 2026 QP conversion factor.

Conversion factor ($)

2. Relative Value Units (RVUs)

Work RVU

Malpractice RVU

Non-Facility PE RVU

Facility PE RVU

3. Geographic Practice Cost Indices (GPCIs)

Work GPCI

Practice Expense GPCI

Malpractice GPCI

Provider charge ($) (optional)

Medicare generally pays based on the lower of the charge or applicable fee schedule amount.

Estimated payment

Before claim-specific reductions, sequestration, modifier adjustments, deductible, secondary coverage, and other payment policies.

Calculated PFS amount

$0.00

Enter RVUs to calculate.

Medicare 80% portion* $0.00

Beneficiary 20% coinsurance* $0.00

Nonparticipating payment amount (95%) $0.00

Nonparticipating limiting charge (109.25%) $0.00

Geographically adjusted total RVU 0.0000

Formula: [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor

Facility vs. non-facility

Select the applicable setting because CMS may assign different practice-expense RVUs depending on where the service is furnished.

Why GPCI matters

CMS adjusts Work, Practice Expense and Malpractice RVUs using locality-specific GPCIs to account for geographic cost variation.

Use official values

For claim decisions, obtain the applicable RVUs, GPCIs, status indicators and payment policies from CMS or your Medicare Administrative Contractor.

Important: This calculator provides an educational estimate of the Medicare Physician Fee Schedule formula. It is not a Medicare claim adjudication system and does not automatically apply modifier reductions, multiple-procedure rules, bilateral/assistant-at-surgery policies, professional/technical component rules, sequestration, MIPS/APM payment adjustments, deductible, coinsurance exceptions, MAC-priced services, locality changes, or other claim-specific policies. Always verify the applicable date of service and official CMS/MAC payment files.

*The 80% / 20% display is a simplified illustration for services where standard Part B coinsurance applies.

Official resources: CMS PFS Look-Up Tool  •  CMS PFS Documentation & Formula