Medicare fee schedule changes for ten PI codes: the four dates that moved the rate

Which dates changed Medicare rates for these ten codes?

Four dates changed the Medicare national amounts for these ten codes: 1 January 2024, 9 March 2024, 1 January 2025 and 1 January 2026. No other date from January 2023 to October 2026 changed any amount in the CMS files we archived. A date of service between two of those dates uses the same amount for each code.

The archive holds 17 releases for that period, 12 of them quarterly updates. None of the 12 moved any of the ten codes in the CMS files we archived.

Five codes publish both settings. 99284 publishes a facility amount only. The other four, 72148, 72141, 70450 and 97110, publish a non-facility amount only. Where CMS prints no amount, we show none. Facility means the physician fee schedule amount when the service is performed in a facility. It is not a hospital payment.

How do I find the right Medicare amount for a date of service?

Use the amount in force on the date of service, not today's amount. Pricing an old date of service at today's amount is the mistake we see most often in bill reviews. For these ten codes, find which period the date falls in, read the amount for the setting, and state that it is the national unadjusted amount.

1. Take the date of service from the bill line, not the date of the bill or of the review. If the line carries no code, first find the code on the bill.
2. Find the period the date falls in. For these ten codes there are five: 1 January 2023 to 31 December 2023, 1 January 2024 to 8 March 2024, 9 March 2024 to 31 December 2024, all of 2025, and 1 January 2026 onward.
3. Read the amount for the setting where the service was performed, non-facility or facility. Each code in Table 1 links to its own page with the amount for each fee-schedule period.
4. State the basis with the figure: national unadjusted, global line, and the date of service.

For example, 99214 with a 2025 date of service is $125.18 (national unadjusted, non-facility), not the $135.61 in force from 1 January 2026. For any other code, the Medicare rate lookup finds the release in force on the date you enter.

What moved on each of the four dates, and by how much?

In date order, non-facility amounts fell, rose, fell and rose again for every code that publishes one. Facility amounts moved the same way on the first three dates. On 1 January 2026 they fell for the five codes that publish both settings and rose 1.54 percent for 99284.

The 9 March 2024 change moved only the conversion factor, from 32.7442 to 33.2875. No relative value unit (RVU) changed, and every non-facility amount rose between 1.65 percent and 1.68 percent. CMS addressed the date in its 2024 CY2025 Physician Fee Schedule final rule (CMS-1807-F). The 2.93 percent increase "applies to services furnished from March 9, 2024 through December 31, 2024" in that rule. The quote states no code's change. The 2.93 percent figure is not the net movement. It replaced an earlier 1.25 percent increase that was already built into the January 2024 conversion factor of 32.7442, so the net observed movement of the non-facility amounts is the smaller 1.65 to 1.68 percent.

CMS stated the January factors in its final rules. The 2023 CY2024 final rule (CMS-1784-F) says "We estimate the CY 2024 PFS CF to be 32.7442". The CY2025 rule says "We estimate the CY 2025 PFS conversion factor to be 32.3465". The 2025 CY2026 final rule (CMS-1832-F) says "We estimate the CY 2026 PFS nonqualifying APM CF to be $33.4009". Each quote supports the factor only.

The January 2023 baseline uses 33.8872, the factor printed in CMS's RVU23A file, not the 33.0607 estimated in the 2022 CY2023 final rule (CMS-1770-F). The CY2024 final rule explains the difference, which comes from the Consolidated Appropriations Act, 2023 (CAA, 2023): "the CAA, 2023 provided a one-year 2.50 percent increase in PFS payment amounts for services furnished in CY 2023", and 33.0607 × 1.025 rounds to 33.8872.

Worked example. For 99214 with a date of service of 1 January 2026, the January 2026 release is in force. Its inputs are a work RVU of 1.92, a non-facility practice expense RVU of 2.00 and a malpractice RVU of 0.14. The conversion factor is 33.4009, the non-qualifying APM factor. The formula is (work + practice expense + malpractice RVU) × conversion factor. Here, (1.92 + 2.00 + 0.14) × 33.4009 rounds once to $135.61 in the non-facility setting. The amount before it was $125.18, so Table 2 shows an 8.33 percent rise.

Which CMS file is RVU26C, and did it change these rates?

RVU26C, the file CMS posts as rvu26c, is the July 2026 release of the physician fee schedule relative value file. It is in force from 1 July 2026 with the conversion factor 33.4009 (non-qualifying APM), and it changed no amount for the ten codes. The letters A to D mark the January, April, July and October releases.

CMS lists the file on its RVU26C page. Table 4 maps every relative value file in our archive to its release and the date it takes effect. Only four of the 17 files changed an amount for the ten codes.

The CMS files carry no effective date of their own. The quarter start dates come from CMS's release labels (A for January, B for April, C for July, D for October), and 9 March 2024 for RVU24AR comes from the CY2025 final rule quoted above. The January 2026 file CMS posts as rvu26a carries a documentation file labeled RVU26AR. The 2026 factor is the non-qualifying APM factor.

Why did none of the quarterly updates in our archive move these ten codes?

The archive supports a narrow answer. In the CMS files we archived, every quarterly update carried the same conversion factor as the release before it. The RVUs of the ten codes did not change on any quarterly date, and no restated record appears for them in our bundles. We do not explain any cause beyond what archived CMS documents state.

A restated record is a later CMS change request that restates one code's record, with its own effective date. Our bundles, the data files we build from each CMS release, carry none for these ten codes.

For 2025 and 2026 we read the archived CMS quarterly files record by record (687 records). Only two hits touched the ten codes: 72141 and 72148, technical-component (modifier TC) supervision-indicator revisions in the July 2026 update, effective 1 January 2026. They do not change the payment amount. For 2023 and 2024 we read only CMS's narrative text, not records.

Across all codes, CMS's 2025 transmittal 13149, "Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2025 Update", lists 105 changed records. The amounts of the ten codes did not move that quarter.

Why did office amounts rise and facility amounts fall in 2026?

For the five codes that publish both settings, the non-facility (office) amount rose on 1 January 2026 and the facility amount fell. Facility means the physician fee schedule amount when the service is performed in a facility, not a hospital payment. For 99214, the non-facility amount rose 8.33 percent to $135.61 and the facility amount fell 9.91 percent to $84.50.

Any statement about 2026 needs its setting, because the two directions are opposite. The five codes are 99213, 99214, 99204, 64483 and 98940. The facility series for 99284 rose 1.54 percent, so facility amounts did not fall for every code.

The inputs show the pattern. Facility practice expense RVUs fell for all five codes, for example 99214 from 0.83 to 0.47. Non-facility practice expense RVUs rose for four of them (99214 from 1.80 to 2.00) and fell for 98940 from 0.35 to 0.34. The conversion factor rose from 32.3465 to the non-qualifying APM factor of 33.4009 and still lifted the non-facility amount for all five. The work RVU also fell between 2025 and 2026 for five of the ten codes: 64483 from 1.90 to 1.85, 70450 from 0.85 to 0.83, 72141 and 72148 from 1.48 to 1.44, and 98940 from 0.46 to 0.45. We attribute no cause.

CMS's published text for 2026 states the facility practice expense change in general terms. The 2025 CY2026 final rule says: "we are finalizing our proposal to reduce the portion of the facility PE RVUs allocated based on work RVUs to half the amount allocated to non-facility PE RVUs beginning in CY 2026." It names no code. We cite it as context, not as the reason any code moved.

How we calculated each figure

We priced each code on each date CMS could have changed it, with the same engine as our free Medicare rate lookup. For each date we found the release in force, read its RVUs and conversion factor, and applied one formula. We wrote the rules down before we read any result, and committed them together with the results, so there is no separate earlier dated record of the rules.

A change date was any release effective date or restated-record date, and the 1 January 2023 baseline is not a change. We compared whole cents and rounded each percent half up at two decimals.

Every figure is the national unadjusted amount for the global line (a line billed with no modifier), with every locality index set to 1.000. Each CMS file used is archived with its sha256 hash, and every hash recomputed from our copy matched. We also recomputed every figure with a separate calculation from its inputs and found no difference.

What can this analysis not tell you?

Figures here are Medicare national unadjusted reference amounts for ten codes on the global line. Nobody is paid exactly these amounts. They say nothing about what any other payer pays or what a provider bills, and they do not describe the fee schedule as a whole.

• National, not local. Medicare payment uses a locality's own indices, and those change each year, so a real claim and a locality's own history can differ.
• Global line only. A line billed with modifier -26 or -TC is a different line.
• Medicare only. For New Jersey PIP, use the separate NJ PIP fee schedule lookup. For what hospitals publish as their own prices, read our article on hospital price transparency files, and for how those prices compare with each hospital's own Medicare amount, see hospital prices compared with Medicare.
• Ten codes, not a census. Do not generalize to other codes.
• Archive starts in January 2023. The baseline is January 2023, not the start of any trend. Later CMS restatements are not reflected.
• Five releases are formula-only. CMS posted no payment file for April 2023, July 2023, October 2023, April 2024 or October 2024. Each dollar there is our formula applied to CMS's RVU file and conversion factor.
• Quarterly check scope. For 2023 and 2024 the check of quarterly updates is prose-only: we read CMS's narrative text, not records. For 2025 and 2026 we read records, and the only two that touched the ten codes (72141 and 72148, modifier TC) are supervision-indicator revisions, not payment changes.
• Prose change tables. For the 2023 and 2024 quarterly releases, CMS described changed records in prose, so no counts exist. A restatement not published in machine-readable form would be absent.
• The 9 March 2024 evidence is the weakest of the four dates. CMS issued no transmittal for it. CMS's own RVU24AR file (PPRRVU24_JAN.csv) prints the conversion factor 33.2875 on 18,499 rows, but no narrative text or transmittal states it. The release's source is CMS's 2024 file listing, "PFS Relative Value Files - RVU24AR".
• 2026 uses the non-qualifying APM conversion factor. That factor is 33.4009. The qualifying factor is 33.5675. With it, 99214 in 2026 would be $136.28 non-facility and $84.93 facility, and no direction changes for any code or setting.