How the Medicare fee schedule lookup works
Every Medicare physician fee is three relative value units (RVUs) for the work, the practice expense and malpractice insurance, each adjusted by a local cost index and multiplied by a single national dollar amount, the conversion factor. CMS publishes all of these numbers in the 2027 final rule and its relative value file, and this lookup applies them for you.[1][2]
Medicare fee = (wRVU × work GPCI + peRVU × PE GPCI + mpRVU × MP GPCI) × CFCF for 2027: $32.6286 (the general rate; clinicians in qualifying alternative payment models get $32.9548).
Worked example. Code 99213 has 1.30 work, 1.42 non-facility practice-expense and 0.10 malpractice RVUs. Nationally that is 2.82 × $32.6286 = $92.01. Manhattan's GPCIs are 1.064, 1.158 and 1.517, so the same visit pays $103.73 there.[3] Across all areas, 99213 runs from $81.64 (Arkansas) to $116.27 (California: San Benito County).
Office (non-facility) vs facility rates
The non-facility rate is what Medicare pays when the service is done in a doctor's office or independent center; the facility rate is lower because the hospital or surgery center bills its own fee for the room, staff and equipment. That separate hospital payment comes from the Outpatient Prospective Payment System, not this fee schedule.[4] So a hospital-based service usually costs more in total even though the doctor's part is smaller. For a full picture of hospital imaging and emergency prices, use the estimators for MRI, CT scans and ER visits.
- "Not paid in this setting" means CMS flags the setting as not applicable, for example a scan's technical component in a hospital, which the hospital bills instead.
- Lab tests are not in this file; they are paid from the Clinical Laboratory Fee Schedule at one national rate.[5] See blood work prices.
Professional and technical components (-26 and -TC)
Diagnostic tests such as X-rays, MRIs and ultrasounds are split into two parts: the technical component (-TC) pays for the machine, the technologist and supplies, and the professional component (-26) pays the radiologist or cardiologist who reads the result. The global fee is the two together. An independent imaging center bills the global fee; a hospital bills its facility fee and the radiologist bills -26.
Medicare rates by CPT code: common services in 2027
| Code | Service (our description) | Office | Facility |
|---|---|---|---|
99203 | Office visit, new patient (low complexity) | $113.55 | $69.17 |
99213 | Office visit, returning patient (low complexity) | $92.01 | $55.14 |
99214 | Office visit, returning patient (moderate complexity) | $131.17 | $82.22 |
99284 | Emergency physician fee, level 4 | $115.83 | $115.83 |
90834 | Psychotherapy, 45 minutes | $124.31 | $99.84 |
90837 | Psychotherapy, 60 minutes | $183.37 | $146.83 |
97162 | Physical therapy evaluation | $97.89 | $97.89 |
92004 | Comprehensive eye exam, new patient | $142.26 | $75.05 |
71046 | Chest X-ray, 2 views | $32.30 | $32.30 |
72148 | MRI lumbar spine without contrast | $189.25 | $189.25 |
73721 | MRI knee (lower-limb joint) without contrast | $200.99 | $200.99 |
70450 | CT head without contrast | $105.72 | $105.72 |
74177 | CT abdomen and pelvis with contrast | $297.90 | $297.90 |
76700 | Abdominal ultrasound, complete | $113.55 | $113.55 |
77067 | Screening mammogram, both breasts | $123.01 | $123.01 |
For emergency visits the table shows only the physician's fee; the hospital adds a facility fee (APC 5021–5025). Status N codes, such as preventive physicals, are not paid by Medicare at all; the lookup still shows what their RVUs imply.
Using the Medicare rate when you pay yourself
The Medicare rate is a fair-price anchor: commercial insurers pay about 117% of Medicare for office visits and 129% for physician services overall, according to the Congressional Budget Office.[6] If you are uninsured, you can ask a practice for a self-pay price near 1.5–2.5 times the Medicare amount, ask for a written good faith estimate before scheduled care,[7] and use the medical bill negotiation calculator on a bill you already have. Our methodology explains how each estimator turns these rates into self-pay ranges.
What changed for 2027CMS finalized the CY 2027 rule on November 4, 2026. The one-year 2.5% payment increase that applied in 2026 expired, and the 1.0 floor on the work GPCI ended, so fees fall slightly in many rural areas. Rates take effect January 1, 2027.
Frequently asked questions
How do I look up Medicare rates by CPT code?
Type the five-character code in the lookup above and pick your state or metro area. The tool applies the 2027 CMS relative value units, your area's GPCIs and the $32.6286 conversion factor, and shows the office and facility amounts.[2]
What is the Medicare conversion factor for 2027?
$32.6286 for most clinicians and $32.9548 for clinicians in qualifying alternative payment models, set in the CY 2027 Physician Fee Schedule final rule.[1]
Why are code descriptions not shown?
CPT code descriptions are copyrighted by the American Medical Association. This lookup shows the public CMS payment data only; check your bill or ask the provider what a code means.
Does the lookup include hospital and lab prices?
No. Hospitals are paid from the Outpatient Prospective Payment System and labs from the Clinical Laboratory Fee Schedule. Our procedure estimators add those payments where they apply.
Sources
- Medicare Program; CY 2027 Payment Policies Under the Physician Fee Schedule (CMS-1848-F)
- PFS Relative Value Files: RVU27A (PPRRVU2027_Jan), released November 10, 2026
- CY 2027 PFS final rule addenda (Addendum D: geographic practice cost indices and GAFs)
- CY 2027 OPPS/ASC final rule with comment period (CMS-1850-FC) and Addenda A and B
- Clinical Laboratory Fee Schedule, CY 2026 fourth quarter release (26CLABQ4)
- The Prices That Commercial Health Insurers and Medicare Pay for Hospitals' and Physicians' Services
- Good faith estimate guide (No Surprises Act, uninsured and self-pay patients)