Medicare Rate Lookup: Highest & Lowest by State
This free Medicare Rate Lookup covers all 17,000+ CPT and HCPCS codes in the Physician Fee Schedule. Type a code, pick a state and a fee-schedule year, and get the highest and lowest Medicare-allowed amount across that state’s payment localities, with office and hospital rates side by side. Every figure is computed straight from the CMS source files for 2023 through 2026, so a bill’s past date of service prices under the schedule that applied. No sign-up.
Highest and lowest, per state, per code
Physician Fee Schedule · 99214 · New York · 2026
| Locality | Locality name | Carrier (MAC) | Effective | Non-facility fee | Facility fee | Highest or lowest |
|---|---|---|---|---|---|---|
| 02 | NYC Suburbs/Long Island | 13202 | 7/2026 | $156.34 | $95.58 | Highest |
| 04 | Queens | 13292 | 7/2026 | $153.94 | $93.53 | |
| 01 | Manhattan | 13202 | 7/2026 | $153.27 | $93.89 | |
| 03 | Poughkpsie/N NYC Suburbs | 13202 | 7/2026 | $145.82 | $89.86 | |
| 99 | Rest Of New York | 13282 | 7/2026 | $130.88 | $82.33 | Lowest |
Source & method
- Rates (RVUs + conversion factor): CMS 2026 National Physician Fee Schedule Relative Value File, July release (RVU26C / PPRRVU2026).
- Prior years (2023 to 2025): each year’s own CMS RVU files. 2025 and 2023 use the year’s final October release (RVU25D, RVU23D). 2024 uses two files because Congress raised the conversion factor mid-year: the January release (RVU24A, $32.7442) for dates of service through March 8, and the final release (RVU24D, $33.2875) from March 9 on. Every prior year carries its own GPCIs and OPPS caps.
- Geographic multipliers (GPCI): CMS Addendum E, the Final CY GPCIs by state and Medicare locality for the selected year, with the statutory 1.0 work-GPCI floor applied.
- Components and imaging caps: professional (-26) and technical (-TC) component RVUs from the same CMS file, and the CMS OPPS-based payment caps that limit the technical component of certain imaging codes to the lower hospital outpatient rate.
- Localities and carriers: the locality number and the Medicare Administrative Contractor (MAC) number shown for each row come from the same CMS Addendum E file, so any figure can be cross-checked against the contractor’s own fee-schedule lookup.
- Live tools to verify: CMS PFS Look-Up Tool and CMS PFS data downloads.
One code, many localities
Localities, not states
Medicare divides the country into payment localities. A state can be one statewide locality or many. Where there are several, the same code is paid differently in each.
Local cost multipliers (GPCI)
Each locality has three geographic multipliers, one each for physician work, practice expense, and malpractice. These are what make a state’s high and low differ.
Highest & lowest
The highest is the code priced in the state’s most expensive locality; the lowest in its cheapest. Single-locality states have one flat rate.
RVUs = the work in the code (national) · GPCIs = local cost (per locality) · CF = one national dollar figure
2026 Medicare rates, explained
What is the Medicare Physician Fee Schedule?
The Medicare Physician Fee Schedule (PFS) is the price list Medicare uses to pay for physician and professional services in the United States. The 2026 schedule carries 17,096 CPT and HCPCS codes, of which 7,740 are directly payable under the standard formula. Each payable code has three relative value units (RVUs) measuring physician work, practice expense, and malpractice risk. Multiplying those RVUs by local cost indices and by the 2026 conversion factor of $33.4009 produces the Medicare-allowed amount. The Centers for Medicare & Medicaid Services (CMS) publishes the schedule as downloadable files and re-issues them every quarter. This page computes its figures directly from the July 2026 release (RVU26C) of those files.
What does Medicare pay for common CPT codes in 2026?
The table below lists the 2026 national Medicare-allowed amounts for twelve frequently billed CPT codes, before any local adjustment. The office column applies when the service is performed in a physician’s office; the hospital column applies in a facility setting. Actual amounts in each state differ between localities, so use the lookup tool above for a state-specific figure.
| Code | Service | Office (non-facility) | Hospital (facility) |
|---|---|---|---|
| 99203 | Office visit, new patient, 30 minutes | $117.57 | $71.48 |
| 99204 | Office visit, new patient, 45 minutes | $177.36 | $116.90 |
| 99205 | Office visit, new patient, 60 minutes | $236.81 | $160.32 |
| 99213 | Office visit, established patient, 20 minutes | $95.19 | $57.45 |
| 99214 | Office visit, established patient, 30 minutes | $135.61 | $84.50 |
| 99215 | Office visit, established patient, 40 minutes | $192.39 | $125.59 |
| 20610 | Joint or bursa injection, major joint | $68.81 | $39.75 |
| 72148 | MRI, lumbar spine, without contrast | $191.72 | $191.72 |
| 73721 | MRI, lower-extremity joint, without contrast | $204.41 | $204.41 |
| 70450 | CT, head or brain, without contrast | $106.55 | $106.55 |
| 93000 | Electrocardiogram (ECG), complete | $15.36 | $15.36 |
| 97110 | Therapeutic exercise, per 15 minutes | $29.06 | $29.06 |
Source: CMS 2026 Physician Fee Schedule, July release (RVU26C), non-QP conversion factor. Rates are per single unit, before the 2 percent sequestration and multiple-procedure (MPPR) reductions.
Why does the same code pay differently across a state?
Medicare divides the country into 109 payment localities across 53 states and territories. In 37 of those jurisdictions the whole state is a single locality, so a code pays one flat rate everywhere. The other 16 have from two to 29 localities, each with its own geographic practice cost indices (GPCIs). California has the most at 29. The spread is real money: office visit 99214 pays $170.02 in the San Jose locality and $140.94 in Rest of California in 2026, a 20.6 percent difference for the same service. For bill review, the defensible answer is the full range, which is exactly what the lookup tool above reports.
Key terms in a Medicare rate lookup
- RVU (relative value unit)
- An RVU is CMS’s measure of the resources a service consumes. Every code carries three: physician work, practice expense, and malpractice.
- GPCI (geographic practice cost index)
- A GPCI is the local cost multiplier applied to each RVU component. Every Medicare locality has its own set of three.
- Conversion factor
- The conversion factor is the national dollar figure that turns RVU points into payment. For 2026 it is $33.4009, or $33.5675 for Qualifying APM Participants.
- Medicare locality
- A locality is the geographic pricing area Medicare uses. There are 109 in 2026, ranging from whole states to single metro counties.
- Carrier / MAC (Medicare Administrative Contractor)
- A MAC is the regional contractor that processes Medicare claims for a locality. Its five-digit number appears on remittances and in fee-schedule files.
- Medicare-allowed amount
- The allowed amount is the maximum Medicare recognizes for a service. Medicare pays 80 percent of it; the patient or a secondary payer owes the rest.
- OPPS cap
- The OPPS cap limits the technical component of certain imaging codes to the lower hospital-outpatient rate, reducing the payable amount below the raw formula result.
How do bill reviewers use these numbers?
Legal nurse consultants, billing experts, and defense attorneys use the Medicare-allowed amount as a benchmark when testing whether billed charges are reasonable. A typical workflow: pull the code from the bill, look up the state’s highest and lowest allowed amounts, then present that range alongside the billed charge in the report. Because every figure traces to a published CMS file, the number stands up to scrutiny in deposition. Medicare-allowed is a floor-style benchmark, so reviewers often pair it with usual-and-customary data, such as our NJ fee schedule and UCR lookup, or a percentage multiplier. For the full workflow, from a stack of bills to a signed expert report, see the Expert Report Engine.
Medicare rates by state, answered
Why does one CPT code have a highest and lowest Medicare rate within a state?
Medicare divides the country into payment localities. A state can be a single statewide locality or several. Where a state has more than one, the same code is paid a different allowed amount in each, because each locality carries its own geographic cost multipliers. The highest is the code priced in the state's most expensive locality; the lowest in its cheapest. A single-locality state pays one flat rate everywhere.
How is the Medicare allowed amount calculated?
For each locality: Allowed = (Work RVU x Work GPCI + Practice Expense RVU x PE GPCI + Malpractice RVU x MP GPCI) x Conversion Factor. The RVUs describe the work in the code and are national; the GPCIs are the local cost multipliers that differ by locality; the conversion factor is a national dollar figure that changes yearly: $33.4009 for 2026 for most clinicians. Qualifying APM Participants are paid on a slightly higher $33.5675.
How current is this data, and how often does it change?
The 2026 figures come from the CMS 2026 Physician Fee Schedule, July release (RVU26C), the quarter in effect now. CMS sets a new conversion factor every January and issues quarterly corrections, so the current year's numbers move each cycle. Prior years, 2023 through 2025, no longer change: 2023 and 2025 are served from each year's final CMS release, and 2024 from the two releases that match its two rate periods. Verify against the CMS PFS Look-Up Tool before using a figure in a report.
Can I look up Medicare rates for a past year, like 2023, 2024, or 2025?
Yes. The Year filter prices any code under the 2023, 2024, 2025, or 2026 fee schedule, each computed from that year's final CMS files with its own conversion factor and geographic cost indices. Pick the year that matches the bill's date of service. 2024 appears twice because Congress raised the conversion factor mid-year: dates of service from January 1 to March 8 price at $32.7442, and March 9 onward at $33.2875. Litigation bills usually carry past dates of service, so pricing them under the current schedule would misstate the benchmark.
Is this what the provider billed, or what Medicare pays?
It is the Medicare-allowed amount, the fee-schedule benchmark, not the provider's billed charge. In bill review it serves as a defensible reference point that traces directly to the CMS source. This tool prices physician and professional services under the Physician Fee Schedule; it does not price hospital facility (OPPS/DRG), clinical lab, DME, or anesthesia schedules.
Which states have a real high-low spread?
About two-thirds of states are a single statewide Medicare locality, so they have one flat rate and no spread. The spread lives in multi-locality states. California has by far the most localities at 29, then Texas at 8, New York at 5, Illinois at 4, and Florida and Missouri at 3 each, with a run of two-locality states after that. In those states the same code can vary meaningfully between the priciest and cheapest area.
What about professional and technical components, and imaging codes?
Many imaging and diagnostic codes split into a professional component (the physician's read, modifier -26) and a technical component (the equipment and staff, modifier -TC). Enter the code with -26 or -TC to price the component instead of the global service. For certain high-cost imaging codes, Medicare caps the technical component at the lower hospital outpatient (OPPS) rate. This tool applies that cap and shows the capped Medicare-allowed amount, which can be well below the raw RVU calculation.