What the amounts mean
- Non-facility is the rate for services in the office or other non-facility setting. Facility is the rate when the service is done in a hospital, ASC or skilled nursing facility, where the facility is paid separately.
- Participating is the Medicare allowed amount for a provider who accepts assignment. Non-participating providers are paid 95% of that.
- Limiting charge is the most a non-participating provider who doesn't accept assignment may bill the patient: 115% of the non-participating amount.
- Amounts are before the patient's deductible and 20% coinsurance, and before the 2% sequestration reduction.
How the amount is calculated
Each code has relative value units (RVUs) for physician work, practice expense and malpractice. Each is multiplied by the locality's geographic index (GPCI), added up, and multiplied by the conversion factor. Since 2026 there are two conversion factors: one for qualifying APM participants and a lower one for everyone else. Some imaging services are capped at the hospital outpatient (OPPS) rate; the tool applies the cap when it's lower.
This tool shows Medicare Part B physician fee schedule amounts only. It doesn't cover Medicare Advantage, Medicaid, no-fault, workers' comp or commercial rates, and it doesn't apply multiple-procedure, bilateral or assistant-surgeon reductions. Carrier-priced codes are set by the local MAC. CPT is a registered trademark of the American Medical Association; code descriptions aren't shown.