Expected-payment calculator

Enter a code, date of service, locality, and setting to see the expected Medicare allowed amount, the 80/20 split, sequestration, and — if you enter what the payer actually paid — the variance.

HCPCS / CPT code

Date of service (release)

Claims pay on the fee schedule in effect on the service date.

Locality

No results found

National (GPCI 1.000)

ALABAMA (AL)

ALASKA* (AK)

ARIZONA (AZ)

ARKANSAS (AR)

ATLANTA (GA)

AUSTIN (TX)

BAKERSFIELD (CA)

BALTIMORE/SURR. CNTYS (MD)

BEAUMONT (TX)

BRAZORIA (TX)

CHICAGO (IL)

CHICO (CA)

COLORADO (CO)

CONNECTICUT (CT)

DALLAS (TX)

DC + MD/VA SUBURBS (DC)

DELAWARE (DE)

DETROIT (MI)

EAST ST. LOUIS (IL)

EL CENTRO (CA)

FORT LAUDERDALE (FL)

FORT WORTH (TX)

FRESNO (CA)

GALVESTON (TX)

HANFORD-CORCORAN (CA)

HAWAII, GUAM (HI)

HOUSTON (TX)

IDAHO (ID)

INDIANA (IN)

IOWA (IA)

KANSAS (KS)

KENTUCKY (KY)

LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)

MADERA (CA)

MANHATTAN (NY)

MERCED (CA)

METROPOLITAN BOSTON (MA)

METROPOLITAN KANSAS CITY (MO)

METROPOLITAN PHILADELPHIA (PA)

METROPOLITAN ST. LOUIS (MO)

MIAMI (FL)

MINNESOTA (MN)

MISSISSIPPI (MS)

MODESTO (CA)

MONTANA** (MT)

NAPA (CA)

NEBRASKA (NE)

NEVADA** (NV)

NEW HAMPSHIRE (NH)

NEW MEXICO (NM)

NEW ORLEANS (LA)

NORTH CAROLINA (NC)

NORTH DAKOTA** (ND)

NORTHERN NJ (NJ)

NYC SUBURBS/LONG ISLAND (NY)

OHIO (OH)

OKLAHOMA (OK)

OXNARD-THOUSAND OAKS-VENTURA (CA)

PORTLAND (OR)

POUGHKPSIE/N NYC SUBURBS (NY)

PUERTO RICO (PR)

QUEENS (NY)

REDDING (CA)

REST OF CALIFORNIA (CA)

REST OF FLORIDA (FL)

REST OF GEORGIA (GA)

REST OF ILLINOIS (IL)

REST OF LOUISIANA (LA)

REST OF MAINE (ME)

REST OF MARYLAND (MD)

REST OF MASSACHUSETTS (MA)

REST OF MICHIGAN (MI)

REST OF MISSOURI (MO)

REST OF NEW JERSEY (NJ)

REST OF NEW YORK (NY)

REST OF OREGON (OR)

REST OF PENNSYLVANIA (PA)

REST OF TEXAS (TX)

REST OF WASHINGTON (WA)

RHODE ISLAND (RI)

RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)

SACRAMENTO-ROSEVILLE-FOLSOM (CA)

SALINAS (CA)

SAN DIEGO-CHULA VISTA-CARLSBAD (CA)

SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)

SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)

SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)

SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)

SAN LUIS OBISPO-PASO ROBLES (CA)

SANTA CRUZ-WATSONVILLE (CA)

SANTA MARIA-SANTA BARBARA (CA)

SANTA ROSA-PETALUMA (CA)

SEATTLE (KING CNTY) (WA)

SOUTH CAROLINA (SC)

SOUTH DAKOTA** (SD)

SOUTHERN MAINE (ME)

STOCKTON (CA)

SUBURBAN CHICAGO (IL)

TENNESSEE (TN)

UTAH (UT)

VALLEJO (CA)

VERMONT (VT)

VIRGINIA (VA)

VIRGIN ISLANDS (VI)

VISALIA (CA)

WEST VIRGINIA (WV)

WISCONSIN (WI)

WYOMING** (WY)

YUBA CITY (CA)

Place of service

Apply sequestration (−2% of the Medicare portion)

Modifier (optional)

Single-line modifiers only — -51 (multiple-procedure reduction) needs a full claim and isn't priced here.

% of Medicare

For commercial contracts priced off Medicare (e.g. 115%).

Actual Medicare paid (optional)

Enter what the payer actually paid to see the variance.

No expected amount for 36415

Status X is not separately payable under the PFS. Release 2026 C · status X (Statutory exclusion)

Statutory exclusion. The service is not in the statutory definition of physician services.

This is a single-line calculator. Batch reconciliation (upload a remittance or a CSV of claims to flag underpayments across a whole book), modifier-adjusted pricing, and API access are on the roadmap.