Medicare Physician Payment
medicare_physician_paymentWhat does Medicare pay a doctor for a procedure code, in a specific place? Returns the relative value units (work, practice expense, malpractice) and the actual dollar payment for a HCPCS/CPT code, adjusted for the Medicare LOCALITY — payment varies geographically, not just by state. Answers "how much does Medicare pay for 99213", "what is code 27130 worth in Los Angeles", "reimbursement rate for an office visit in Texas", and fee-schedule or contract-rate benchmarking. Gives both the facility and non-facility amount (a procedure pays less in a hospital, because the hospital bills the overhead separately), the global period, and the status code saying whether the code is separately payable at all. States the fee-schedule YEAR and the locality it resolved to on every response, because a rate quoted for the wrong year or locality is a wrong number. Sourced from the CMS Physician Fee Schedule relative value files.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | HCPCS or CPT code, e.g. "99213" (office visit) or "27130" (hip replacement). | |
| year | No | Fee-schedule year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response. | |
| locality | No | Where the service is provided — a state code ("CA"), state name, or Medicare locality name ("Bakersfield", "Manhattan"). Payment varies by locality; omit only if you want the national picture. | |
| modifier | No | Optional HCPCS modifier, e.g. "26" (professional component) or "TC" (technical component). |