Trust the source. See the method.

How the benchmark is calculated

Multiply each relative value unit (RVU) by its corresponding geographic practice cost index (GPCI), add the three results, then multiply by the schedule’s conversion factor. Round the final amount to cents.

The facility selector changes the practice expense RVU. The QP selector uses the separate CMS QP row when available. In this release, the non-QP conversion factor is 33.4009 and the QP factor is 33.5675. Professional (26), technical (TC), and unmodified components use their own published rows.

The national reference sets all three GPCIs to 1.000. It is not an average of actual claims or geographically weighted utilization. The locality median is the median of the calculated amounts across all 109 localities.

Unavailable means unavailable

Only status A, R, or T rows with applicable settings and usable RVUs receive a benchmark. Restricted and conditional statuses remain labeled. Contractor-priced, anesthesia, bundled, noncovered, unavailable-setting and missing-QP rows do not become misleading $0 estimates.

What the benchmark excludes

The RVU calculation does not implement OPPS imaging caps, multiple-procedure or therapy reductions, bilateral or assistant-at-surgery adjustments, MIPS adjustments, sequestration, deductible or coinsurance, nonparticipating provider adjustments, geographic bonuses, payer contracts, or coverage/medical necessity checks. Facility describes the physician service setting; it is not a hospital facility fee.

NCCI scope

The checker uses all four Medicare practitioner procedure-to-procedure files for Q3 2026. It evaluates both directions and filters by the edit’s effective/deletion dates.

It does not check hospital outpatient PTP edits, Medicaid edits, medically unlikely edits (MUEs), add-on-code edits, commercial payer policies, modifiers on actual claim lines, or coverage. No matching edit does not mean a claim will be paid.

ICD-10 scope

Descriptions and billable flags come from the official FY 2026 April order file. The full tabular notes, clinical coding guidance and sequencing rules are not reproduced here. A billable diagnosis is not a coverage determination.

Privacy & storage

This is a public research workspace. No patient data is required. Saved codes and pricing preferences are stored in this browser. CSV amounts are analyzed locally; only procedure codes and pricing context reach the application server.

No user accounts, claim submission, EHR connections, payment processing, or shared clinical records are configured.

Attribution & licensing

CPT codes and descriptions © 2026 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. Dental codes © 2026 American Dental Association. MedPayIQ is independent of CMS and the AMA.

Confirm the applicable data and descriptor licenses before redistributing or launching a public commercial service. Original CMS archives include release-specific notices and documentation.