Fee Schedules define the allowed amounts for each CPT/HCPCS code. Medicare rates are published annually by CMS. Custom rates can override Medicare for specific payer contracts.
Fee Schedules
Manage CPT rates, GAF adjustments, and custom fee schedules
Schedules
Medicare 2026
Medicare 2025
BCBS Custom
Cigna Custom
Internal Reference
CPT Rate Table — Medicare 2026
Effective: Jan 1, 2026
Active
| CPT Code | Description | Specialty | Medicare Rate | Custom Rate | GAF Adj. | Diff. | Actions |
|---|---|---|---|---|---|---|---|
| 99213 | Office/outpatient E&M, est. patient, low complexity | E&M | $73.18 | $80.50 | 1.042 | +10.0% | |
| 99214 | Office/outpatient E&M, est. patient, mod. complexity | E&M | $109.48 | $118.00 | 1.042 | +7.8% | |
| 99215 | Office/outpatient E&M, est. patient, high complexity | E&M | $148.25 | $148.25 | 1.042 | 0% | |
| 99232 | Subsequent hospital care, low complexity | E&M | $74.49 | $70.00 | 1.042 | -6.0% | |
| 99233 | Subsequent hospital care, mod. complexity | E&M | $109.42 | $110.00 | 1.042 | +0.5% | |
| 36415 | Venipuncture, routine | Lab | $3.00 | $3.00 | 1.042 | 0% | |
| 93000 | Electrocardiogram, routine 12-lead | Cardiology | $17.11 | $19.00 | 1.042 | +11.0% | |
| 71046 | Radiologic exam, chest 2 views | Radiology | $25.75 | $25.75 | 1.042 | 0% | |
| 99304 | Nursing facility care, initial, low complexity | E&M | $100.68 | $105.00 | 1.042 | +4.3% | |
| 99308 | Nursing facility care, subsequent, low complexity | E&M | $61.59 | $65.00 | 1.042 | +5.5% | |
| 99309 | Nursing facility care, subsequent, mod. complexity | E&M | $81.68 | $81.68 | 1.042 | 0% | |
| 99341 | Home or residence visit, new patient, low complexity | E&M | $77.71 | $82.00 | 1.042 | +5.5% | |
| 99345 | Home or residence visit, new patient, high complexity | E&M | $188.86 | $195.00 | 1.042 | +3.2% | |
| G0438 | Annual wellness visit, initial | Preventive | $171.02 | $171.02 | 1.042 | 0% | |
| G0439 | Annual wellness visit, subsequent | Preventive | $117.22 | $120.00 | 1.042 | +2.4% | |
| 99490 | Chronic care management, 20 min | Care Mgmt | $62.51 | $62.51 | 1.042 | 0% | |
| 99491 | Chronic care management, physician 30 min | Care Mgmt | $82.40 | $85.00 | 1.042 | +3.1% | |
| 99495 | Transitional care management, moderate complexity | Care Mgmt | $165.89 | $170.00 | 1.042 | +2.5% | |
| 99496 | Transitional care management, high complexity | Care Mgmt | $225.57 | $225.57 | 1.042 | 0% | |
| 90837 | Psychotherapy, 60 min | Behavioral | $122.32 | $130.00 | 1.042 | +6.3% |
Showing 1–20 of 8,423 codes
Geographic Adjustment Factor (GAF) by State
| State | Locality | Work RVU Factor | PE RVU Factor | MP RVU Factor | Composite GAF |
|---|---|---|---|---|---|
| California | San Francisco | 1.156 | 1.482 | 0.952 | 1.297 |
| New York | Manhattan | 1.098 | 1.356 | 1.102 | 1.212 |
| Florida | Miami | 1.042 | 1.124 | 1.156 | 1.098 |
| Texas | Dallas | 1.008 | 1.042 | 0.988 | 1.024 |
| Illinois | Chicago | 1.038 | 1.152 | 1.022 | 1.085 |
| Rest of Nation | Non-CBSA | 0.988 | 0.912 | 0.876 | 0.942 |