What Medicare pays,
computed correctly.
Look up the real fee schedule amount for any CPT or HCPCS code — GPCI math, status-driven payability, and sequestration handled, with every rate cited back to the CMS file, row, and formula that produced it.
Popular: 99213 99213 Established Patient Office Visit, Level 3 Common for routine follow-up of one or two stable chronic conditions or a new but minor problem — think a blood-pressure check-in or a sprained ankle. View rate & details → 99214 99214 Established Patient Office Visit, Level 4 Common for managing multiple or worsening chronic conditions, starting a new prescription, or a problem that needs ongoing drug-therapy monitoring. View rate & details → 99203 99203 New Patient Office Visit, Level 3 Typical for a new patient with a single, uncomplicated problem or one stable condition being established with the practice. View rate & details → 93000 93000 Electrocardiogram (ECG), Complete Ordered to evaluate chest pain, palpitations, or as part of a routine cardiac work-up. View rate & details → 36415 36415 Routine Venipuncture (Blood Draw) Reported whenever blood is drawn by needle stick for laboratory testing, regardless of which tests are ordered on the sample. View rate & details →
Rates vary by area — look up your locality by ZIP code.
Building on it? Start with a free API key → · 100 lookups a month free, no card required
Three ways to get a rate
The same computed, versioned data underneath. Pick the surface that fits how you work.
Free rate lookup
A page for every code: the national amount, the RVU math behind it, payability in plain English, and rate history across quarters. No login, no paywall.
- Non-facility and facility amounts
- Rate history with release-over-release change
- A source popover per price: CMS file, row, and the math
- Expected-payment calculator for your locality
REST API
One JSON request returns the computed amount, the payability decision, and citations down to the CMS file row that produced every input. Self-serve keys, free tier to start.
- Historical lookups by year + quarter
- Locality by MAC code or plain ZIP
- Gross or sequestration-net with one flag
- payable=false always carries a reason
- Anesthesia codes: pass case time, get the real allowed amount
RCM dashboard
Compare rates across localities and quarters, track how the codes you bill moved release over release, and export the sets your team works from.
- Cross-quarter rate deltas
- Bulk export & saved code sets
- Locality comparison views
Correctness is the product
Anyone can join a CSV. The hard part is the edge cases that quietly produce wrong money — a blank RVU treated as $0, a status code that isn't actually payable, a rate pulled from the wrong quarter. Each one is a denied claim or an appeal you can't back up. These are the rules we hold ourselves to instead.
The real payment formula
(work + PE + MP) × the GPCIs × conversion factor, with the PE component matched to your setting.
Immutable, versioned releases
A new quarter is a new ingest — "the rate in Q2 2024" stays answerable forever.
Status-driven payability
A/R/T pay; B/I/N/P/M/X/E don't. The status indicator decides, never the dollar value.
Blank RVU is not zero
Carrier-priced codes return payable=false with a reason — never a fake $0 that slips into a claim.
Sequestration is your choice
The ~2% cut applies after the formula, only when you ask. Gross or net, one flag.
Every answer is attributable
Each response cites the release, the CMS file and row every value was read from, and the math it was plugged into — for appeals teams who must show their work.
OPPS caps applied automatically
When a code's non-facility payment is capped at the OPPS site-of-service amount, we apply it — no manual cross-check against a second CMS file.
Anesthesia priced by time, not guesswork
Status J codes don't use the standard RVU formula. Give us the case time and locality and we compute base units + time units × the anesthesia conversion factor — the calculation that actually determines what anesthesia claims pay.
One request. A rate you can defend.
Pass a code, a locality — or just a ZIP — a setting, and (optionally) a historical quarter. Get back the computed amount, the payability decision, and citations naming the CMS file, row, and math behind every number.
- Ask for a past quarter and get that quarter's answer, not today's
- Send a ZIP and we resolve the payment locality through the versioned crosswalk — ambiguous ZIPs error, they never guess
- Every value cited to its CMS file, row, and column, with the formula shown
- payable=false comes with a machine-readable reason
- Facility vs non-facility selected explicitly, never guessed
# request
curl https://medicalfeeschedules.com/v1/rates/99213 \
-H "Authorization: Bearer sk_live_…" \
-d zip=90210 # or locality=… \
-d setting=non_facility \
-d year=2026 -d quarter=C
# response
{
"code": "99213",
"payable": true,
"status": "A",
"amount": "95.19",
"sequestration_applied": false,
"release": { "schedule": "pfs", "year": 2026, "quarter": "C" },
"citations": {
"sources": { "rvu": { "file": "PPRRVU2026_Jul_nonQPP.csv", "row": 12954, … }, "gpci": { … }, "zip_locality": { … } },
"calculation": {
"formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
"inputs": { "work_rvu": 1.3, "work_gpci": 1, "pe_rvu": 1.46, "pe_gpci": 1, "mp_rvu": 0.09, "mp_gpci": 1, "conversion_factor": 33.4009 }
}
}
}A dashboard built for RCM teams
The lookup tool and API answer "what does this code pay." The dashboard is for the next question: how did the codes we bill move this quarter, how do localities compare, and which sets do we need to re-check before the next release. We're building it now with the billing and RCM teams asking for it — join the waitlist and help shape what ships first.
- Cross-quarter rate deltas for the codes you track
- Bulk export and saved code sets for your workflow
- Locality comparison views for negotiation and budgeting
Also on the roadmap
Bulk reconciliation
Upload a CSV of codes and localities, get computed rates and payability back in one pass.
Payer rate comparison
Stack a negotiated payer rate against the Medicare rate to spot underpayment fast.
wRVU compensation modeling
Model physician compensation off work RVUs using the same versioned release data.
Simple, honest pricing
Browse for free. Pay when you build on it.
Pro
- 10,000 API lookups / mo
- Full historical quarters
- Dashboard & exports (early access)
- Sequestration toggle
Team
- Unlimited lookups
- SLA & priority support
- Bulk & scheduled exports
- Invoiced billing
The dashboard is in development — Pro and Team subscribers get early access as it ships. Join the waitlist to be first in line.
Stop re-parsing CMS spreadsheets
The manual process breaks every quarter when CMS reshuffles its columns — and a misread blank RVU turns into a denied claim. One request replaces all of it. Get a computed, versioned rate, cited down to the CMS file row — free key, no card.