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Medicare Payment Reference

Medicare Fee Schedule, by State and MAC

Medicare does not pay one flat rate. Your payment depends on your state, your MAC, and your payment locality. Pick your state below to find your MAC and jurisdiction, then follow the official link to the fee schedule.

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Find Your MAC and Jurisdiction

Select your state. We will show you your Medicare A/B MAC, its jurisdiction code, and where to look up the official fee schedule.

MAC assignments change from time to time. Confirm against the current HHS MAC website list before relying on it for enrollment or billing decisions.

The Math

How Medicare Calculates Your Payment

Every CPT code has a price built from three cost pieces, adjusted for your location, then multiplied into dollars.

Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor

MPFS = Medicare Physician Fee Schedule. RVU = relative value unit. GPCI = geographic practice cost index.

Work RVU × Work GPCI

The clinician's time, skill and effort for the service, adjusted for local wage costs.

PE RVU × PE GPCI

Practice expense: rent, staff and equipment, adjusted for local operating costs.

MP RVU × MP GPCI

Malpractice insurance cost for the specialty, adjusted for local premium levels.

Conversion Factor. The dollar multiplier CMS sets each year. It turns the total RVUs into an actual dollar payment.

2026 Rates

2026 Conversion Factors

For the first time, Medicare runs two conversion factors in 2026 under MACRA. Which one applies to you depends on your APM status.

Who2026 conversion factor2025 (for reference)
Qualifying APM participants$33.5675$32.3465
Everyone else$33.4009

The dual conversion factor started in 2026 under MACRA. A qualifying APM participant is a clinician in an Advanced Alternative Payment Model who meets the payment or patient thresholds. If that is not you, the standard $33.4009 factor applies.

Geography

Why Your State Matters

The same CPT code pays differently in different places. That is by design.

GPCI localities

CMS divides the country into payment localities. Each locality gets its own geographic cost indexes for work, practice expense and malpractice.

Same code, different pay

A high-cost area like Manhattan gets a higher locality adjustment than rural Iowa. Identical service, different Medicare payment.

Your MAC publishes it

Your MAC publishes the locality-adjusted fee schedule for its jurisdiction. That file, not the national average, is what you actually get paid.

This is why checking the right MAC matters. Billing off the national fee schedule instead of your locality-adjusted one leads to wrong expectations and missed underpayments. We compare every Medicare payment against the correct locality file during our audits.

Go Deeper

Official Sources

Bookmark these. They are the actual sources of truth behind this page.

1

CMS Physician Fee Schedule

The official CMS page for the Physician Fee Schedule: payment rules, conversion factors, RVU files and downloads.

Open the CMS fee schedule page

2

HHS MAC Website List

The official list of every Medicare Administrative Contractor website by jurisdiction. Find your MAC's fee schedule lookup here.

Open the HHS MAC website list

3

CGS NCCI PTP Lookup

Before you bill, check your code pairs against the official NCCI Procedure-to-Procedure edit lookup from CGS Medicare.

Open the CGS PTP lookup

FAQ

Fee Schedule Questions

Straight answers on Medicare payment.

What is the Medicare Physician Fee Schedule?
It is the national price list Medicare uses to pay physicians and other clinicians for Part B services. Every CPT and HCPCS code gets a payment built from RVUs, geographic adjustments and the annual conversion factor.
How do I find the fee for a specific CPT code in my state?
First find your MAC using the lookup above. Then open your MAC's website from the HHS MAC website list and use its fee schedule search. Enter the CPT code and your payment locality for the exact allowed amount.
What is the difference between the two 2026 conversion factors?
Clinicians who are qualifying participants in an Advanced APM get $33.5675. Everyone else gets $33.4009. The split started in 2026 under MACRA and rewards participation in value-based payment models.
What is a MAC and why does my state determine mine?
A Medicare Administrative Contractor is the company CMS hires to process Medicare claims for a region called a jurisdiction. CMS assigns each state to a jurisdiction, so your state decides which MAC handles your claims and publishes your locality-adjusted fee schedule.
Does the fee schedule change every year?
Yes. CMS updates the conversion factor, RVU values and GPCI localities every year through rulemaking. Always check the current year file before quoting a Medicare payment to a practice.

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