Medicare Physician Fee Schedule amounts by code, date and locality, traced to archived CMS files.
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Use this when you need what Medicare's Physician Fee Schedule allows for a CPT or HCPCS code on a given date of service, for the nation or for one state or locality, in the office or facility setting. It takes up to 25 lines (code, modifier, date of service) and returns one answer per line, in order: CMS's allowed amount (national figure, plus the state range or one locality's figure when a state is given), the CMS release in force on that date, its source files with SHA-256 checksums, and the release catalog URL. It covers dates of service from Jan 1, 2023 through Dec 31, 2026; each date is priced under the quarterly CMS release in force that day, and a date outside that span gets a reason instead of a figure. A code with no national rate on this schedule (bundled, carrier-priced, laboratory, drug, anesthesia, ambulance, supplies, or absent from that release) returns a result_kind and a reason, not an error, and a malformed line returns an error for that line only. Do not use it for hospital outpatient or inpatient facility payments, ambulatory surgery center fees, Medicaid, commercial or workers' compensation rates, CPT code descriptions, or opinions on whether a charge is reasonable. It is read-only; amounts are Medicare-allowed amounts per unit, before sequestration and multiple-procedure reductions.
One to 25 service lines to price. The answers come back in this order.
Optional, applies to every line. Two-letter key or full name of a state, DC, Puerto Rico or the Virgin Islands. Leave it out for the national figure only. Example: NJ.
Optional, applies to every line. concise (default) returns the national figure and the state range. detailed lists every locality in the state, with the geographic indexes used, and needs state.
Optional, applies to every line. Which setting the headline figure reports: office (non-facility) or facility (hospital). Both settings are always in the figures. Leave it out for the setting CMS shows first.
Optional, applies to every line, needs state. CMS locality number inside that state. Leave it out to get the state's range. Example: 01.
Use this when you need what Medicare's Physician Fee Schedule allows for a CPT or HCPCS code on a given date of service, for the nation or for one state or locality, in the office or facility setting. It takes up to 25 lines (code, modifier, date of service) and returns one answer per line, in order: CMS's allowed amount (national figure, plus the state range or one locality's figure when a state is given), the CMS release in force on that date, its source files with SHA-256 checksums, and the release catalog URL. It covers dates of service from Jan 1, 2023 through Dec 31, 2026; each date is priced under the quarterly CMS release in force that day, and a date outside that span gets a reason instead of a figure. A code with no national rate on this schedule (bundled, carrier-priced, laboratory, drug, anesthesia, ambulance, supplies, or absent from that release) returns a result_kind and a reason, not an error, and a malformed line returns an error for that line only. Do not use it for hospital outpatient or inpatient facility payments, ambulatory surgery center fees, Medicaid, commercial or workers' compensation rates, CPT code descriptions, or opinions on whether a charge is reasonable. It is read-only; amounts are Medicare-allowed amounts per unit, before sequestration and multiple-procedure reductions.
| Argument | Type | Description |
|---|---|---|
| lines* | array | One to 25 service lines to price. The answers come back in this order. |
| state | string | Optional, applies to every line. Two-letter key or full name of a state, DC, Puerto Rico or the Virgin Islands. Leave it out for the national figure only. Example: NJ. |
| detail | string | Optional, applies to every line. concise (default) returns the national figure and the state range. detailed lists every locality in the state, with the geographic indexes used, and needs state. |
| setting | string | Optional, applies to every line. Which setting the headline figure reports: office (non-facility) or facility (hospital). Both settings are always in the figures. Leave it out for the setting CMS shows first. |
| locality | string | Optional, applies to every line, needs state. CMS locality number inside that state. Leave it out to get the state's range. Example: 01. |
{
"type": "object",
"required": [
"lines"
],
"properties": {
"lines": {
"type": "array",
"items": {
"type": "object",
"required": [
"code",
"date_of_service"
],
"properties": {
"code": {
"type": "string",
"maxLength": 16,
"description": "CPT or HCPCS code: five digits, four digits and a letter, or a letter and four digits. Case and spaces do not matter, and a trailing modifier is accepted. Example: 12345."
},
"modifier": {
"type": "string",
"maxLength": 8,
"description": "Optional. none or empty for the whole (global) service, 26 for the professional component, TC for the technical component, or 53 for a discontinued procedure. Example: 26."
},
"date_of_service": {
"type": "string",
"maxLength": 24,
"description": "Date the service was provided: YYYY-MM-DD, or MM/DD/YYYY with the month first, or a written date. The year has four digits. Example: 2025-06-17."
}
}
},
"maxItems": 25,
"minItems": 1,
"description": "One to 25 service lines to price. The answers come back in this order."
},
"state": {
"type": "string",
"maxLength": 24,
"description": "Optional, applies to every line. Two-letter key or full name of a state, DC, Puerto Rico or the Virgin Islands. Leave it out for the national figure only. Example: NJ."
},
"detail": {
"enum": [
"concise",
"detailed"
],
"type": "string",
"description": "Optional, applies to every line. concise (default) returns the national figure and the state range. detailed lists every locality in the state, with the geographic indexes used, and needs state."
},
"setting": {
"enum": [
"office",
"facility"
],
"type": "string",
"description": "Optional, applies to every line. Which setting the headline figure reports: office (non-facility) or facility (hospital). Both settings are always in the figures. Leave it out for the setting CMS shows first."
},
"locality": {
"type": "string",
"maxLength": 4,
"description": "Optional, applies to every line, needs state. CMS locality number inside that state. Leave it out to get the state's range. Example: 01."
}
}
}Use this when you need to know which CMS Medicare Physician Fee Schedule releases the archive holds, with their effective dates, CMS source files, SHA-256 checksums and any gaps in coverage, before or instead of looking up a fee. It takes no input and returns every release, newest first (id, label, effective and end dates, the CMS document that fixed the dates, source files, the hosted data bundle), plus the coverage summary and the release catalog URL. Coverage runs from Jan 1, 2023 through Dec 31, 2026, and the list changes only when a new CMS release is archived. Do not use it to get a fee amount (use medicare_get_physician_fee), or for other Medicare schedules such as hospital outpatient, ambulatory surgery center, laboratory, ambulance or DMEPOS, or for Medicaid or commercial rates. It is read-only.
No arguments.
{
"type": "object",
"additionalProperties": false
}