Procedure
No code selected.
Locality
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Site of service
Conversion factor
Geographic adjustment mode
Weights: Work 50.866% · PE 44.839% · MP 4.295% (2006-based MEI cost-share weights, currently in effect for CY2026)
Select a procedure code and a locality to calculate the payment.
Formula: Payment = [(Work RVU × PW GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor.
PW GPCI is applied with the CMS 1.0 floor. PE RVU and PE GPCI vary by non-facility vs. facility setting; Work and MP RVUs do not.
County-level locality is resolved via the 26LOCCO crosswalk; counties not individually enumerated fall back to that state's residual locality
("Rest of State" / "All Other Counties"). This tool does not apply multiple-procedure, bilateral, therapy, or OPPS-cap adjustments — it prices a single code as billed.
Glossary
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| MPFS | Medicare Physician Fee Schedule — the payment system for physician/practitioner professional services (as opposed to hospital facility payments under IPPS/OPPS). |
| RVU | Relative Value Unit — the unit of measure for the resources required to furnish a service, set per HCPCS/CPT code. |
| Work RVU | The RVU component reflecting physician time, skill, effort, judgment, and stress for a service. |
| PE / PE RVU | Practice Expense — the RVU component reflecting overhead costs (rent, staff wages, equipment, supplies). Set separately for facility and non-facility settings. |
| MP / MP RVU | Malpractice — the RVU component reflecting professional liability (malpractice) insurance costs. |
| GPCI | Geographic Practice Cost Index — a locality-specific index (one each for Work, PE, and MP) measuring an area's costs relative to the national average (1.000). |
| PW GPCI | Physician Work GPCI. Statutorily floored at 1.000 — no locality can fall below the national average on this component. |
| CF | Conversion Factor — the national dollar multiplier applied to total adjusted RVUs to produce a payment amount. Two CFs apply for CY2026 depending on APM participation. |
| QP | Qualifying (Advanced) APM Participant — a practitioner who meets CMS's threshold for participation in an Advanced Alternative Payment Model, qualifying them for the higher CY2026 conversion factor. |
| Non-QP | A practitioner who does not meet QP status; paid under the standard (lower) CY2026 conversion factor. |
| HCPCS | Healthcare Common Procedure Coding System — the code set (includes CPT codes and Level II codes) identifying billable services. |
| CPT | Current Procedural Terminology — the AMA-maintained code set for medical procedures and services; forms HCPCS Level I. |
| GAF | Geographic Adjustment Factor — a composite index combining the three GPCIs into one number, weighted by each component's national average share of total RVUs (per the Medicare Economic Index). |
| MEI | Medicare Economic Index — CMS's measure of practice cost inflation; its cost-share weights (Work/PE/MP) are used to compute the GAF. Currently based on 2006 data; a newer rebasing has been repeatedly delayed by CMS. |
| MAC | Medicare Administrative Contractor — the private contractor administering Medicare claims for a given jurisdiction/locality. |
| Locality | A CMS-defined payment area (statewide or sub-state) sharing one set of GPCI values. There are 109 payment localities nationally. |
| Non-facility | Site-of-service setting for care delivered outside a hospital/facility (e.g., a physician's own office); uses the non-facility PE RVU. |
| Facility | Site-of-service setting for care delivered in a hospital, ASC, or similar facility; uses the (typically lower) facility PE RVU, since the facility itself bears some overhead costs separately. |
| Status Code | Indicator of a HCPCS code's payment status under the MPFS (e.g., "A" = active/separately payable, "C" = contractor-priced, "R" = restricted coverage, "T" = injection, paid only if no other service billed same day). |
| Global Days / Global Period | The pre- and post-operative period bundled into a surgical procedure's payment (e.g., 000, 010, 090 days), during which related E/M visits are generally not separately payable. |