What does Medicare pay for this CPT or HCPCS code at this ZIP? Physician Fee Schedule facility and non-facility allowed amounts with the RVUs and GPCIs behind them, any US ZIP or Medicare locality, 2025 on, computed by Distill from CMS’s quarterly RVU files
medicare_pfs_rateWhat does Medicare pay for this CPT or HCPCS code at this ZIP? Physician Fee Schedule facility and non-facility allowed amounts with the RVUs and GPCIs behind them, any US ZIP or Medicare locality, 2025 on, computed by Distill from CMS’s quarterly RVU files. From CMS’s quarterly relative value files (RVU25A on): the facility and non-facility allowed amounts for one code (and modifier) in the locality of a ZIP, ZIP+4 or MAC-locality id, with the RVUs, GPCIs and conversion factor (non-QP and QP) behind them, the OPPS cap, the limiting charge, the payment indicators and the same amounts in every release since 2025A. Pass exactly one of zip or locality. Codes CMS does not price (status other than A, R, T) answer with null amounts; unknown codes and ZIPs answer 404 and are not charged. Refreshed quarterly (live freshness: /status). Price: $0.01 per call. Free tier: 3 free calls a day per IP, at most 3 rows per answer, taken by an unpaid call unless its _meta["distill/free-tier"] is "skip". Answers in a summary view of about 3,000 tokens; view: "full" for every row. Confidence: agreement × freshness. Agreement: for a 5-digit ZIP that CMS splits across localities by ZIP+4, the share of its ZIP+4 codes in the answered locality; 1 for a ZIP+4, a locality or a ZIP in one locality. Freshness: 1 until the first day of the calendar quarter after the CMS files were last checked, then halving every 30 days. The amounts themselves are exact (they agree with CMS’s carrier payment files to the cent). Medicare Physician Fee Schedule amounts computed from CMS’s published RVU, GPCI and conversion-factor files: what Original Medicare allows a participating clinician (before deductible and coinsurance), not what another payer pays; not a quote, not medical, billing or coding advice. See /terms. CPT® codes are served as codes only: their descriptors are AMA copyright and are never included (nor dental CDT descriptors). CPT is a registered trademark of the American Medical Association. HCPCS Level II descriptions are CMS’s.
Tool call template
Replace each placeholder with a value matching the input schema. Only required parameters are included; add optional parameters as needed.
{
"id": 1,
"jsonrpc": "2.0",
"method": "tools/call",
"params": {
"arguments": {
"code": "<code>"
},
"name": "medicare_pfs_rate"
}
}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| zip | No | A 5-digit ZIP or ZIP+4 (80218 or 80218-1234). | |
| code | Yes | The HCPCS Level II or CPT code, e.g. 99213, 70551 or G0439. | |
| date | No | The date of service, YYYY-MM-DD (default: today, UTC): picks the release in force. | |
| view | No | summary (the default): the answer a model needs, budgeted; full: every row (a free answer stays capped). | |
| release | No | A quarterly release instead of a date, e.g. 2026D (A from 1 Jan, B Apr, C Jul, D Oct). | |
| setting | No | Only this setting’s amount (default: both). | |
| locality | No | A Medicare locality as MAC-locality, e.g. 04112-01 (Colorado). | |
| modifier | No | Optional modifier with its own RVUs: 26 (professional component), TC (technical component) or 53. Omit for the global service. |