Know the rate. Have the proof.
Look up a Medicare allowed amount by code, locality, and date of service, then see the CMS file and source row behind it.
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- Code
- 99213
- Service ZIP
- 60657
- Date of service
- Oct 1, 2026
- Setting
- Office (non-facility)
Locality 16 · 
Chicago, IL
Participating · No modifiers · 1 unit
Q4 2026 release
Locality-adjusted allowed amount
$99.63
in a doctor’s own office or clinic
104.7% of the $95.19 national baseline
- Medicare share (80%)
- $79.70
- Sequestration (−2%)
- −$1.59
- Net Medicare payment
- $78.11
- Coinsurance (20%)
- $19.93
- Expected total to provider
- $98.04
Assumes the Part B deductible is met.
( Work1.30 × 1.007 + Practice exp.1.46 × 1.005 + Malpractice0.09 × 2.295 ) × Conv. factor$33.4009 = $99.63
PPRRVU2026_Oct_nonQPP.csv · row 13,015 GPCI2026.csv · row 48
Wrong numbers rarely look wrong.
A blank RVU can look like $0 in a spreadsheet. A stale release can look just as plausible. Either one can end up in front of a client.
The right release for the date of service
CMS split 2024’s first quarter on March 9: new rates took effect that day. Localis uses the rates in effect on the date of service.
- RVU24A
- CF 32.7442
- RVU24AR
- CF 33.2875
Blank RVUs need an explanation
A blank RVU doesn’t mean Medicare allows $0. Localis tells you why no national amount is available.
Not a $0.00 allowance.
No national PFS rate
Status C · contractor-priced · RVUs blank
Every amount traces to a source row
Open any amount to see its source file and row, inputs, and formula.
RVUs
PPRRVU2026_Jul_nonQPP.csv · row 7,347
GPCIs · Chicago, IL
GPCI2026.csv · row 48
66984 · Facility · Q3 2026$488.66
Your regular codes, already priced.
Bookmark your clients’ codes and localities. Click any amount to see how it was calculated.
- Your codes across your localitiesUp to 10 codes in up to 10 localities.
- Apples to applesEvery amount uses the same setting, participation status, and release.
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Facility · Participating · No modifiers · 1 unit
Non-QP · Q3 2026 · Sequestration excluded
| Code | Chicago, IL06102-16 |
|---|---|
| 66984 | $488.66 Saved calculation |
Behind this amount
The Q3 2026 national PFS baseline is $462.60. Chicago’s geographic adjustment brings the facility allowed amount to $488.66.
PPRRVU2026_Jul_nonQPP.csv · row 7,347
GPCI2026.csv · row 48
Three questions your clients keep asking.
Each tool starts with the Medicare allowed amount and shows you the math.
- Expected allowed
- $488.66
- Paid (example)
- $470.00
- Variance to review
- −$18.66
66984 · Chicago, IL · Facility · Q3 2026
Was this line paid correctly?
Enter the code, date, and paid amount to see the variance.
Open the calculator →- Medicare allowed
- $488.66
- Offer (example)
- 110% of Medicare
- Contracted rate
- $537.53
66984 · Chicago, IL · Facility · Q3 2026
Is this payer offer any good?
Turn “110% of Medicare” into dollars across the codes a practice actually bills.
Check a payer offer →- Q3 2024
- $563.92
- Q3 2026
- $488.66
- Change
- −$75.26
66984 · Chicago, IL · Facility
What did the new release do to my codes?
See which allowed amounts went up or down, and by how much.
Review rate changes →Know what your group should be collecting.
If your payer contracts pay a percentage of Medicare, start with the allowed amount for each code and locality.
- 110% of Q3 2024 Medicare
- $620.31
- 110% of Q3 2026 Medicare
- $537.53
- Difference per service
- $82.78
Example · 66984 · Chicago, IL · Facility
-
Check a payer offer →
A payer offer is on your desk
See what the offer pays across your code mix.
-
Price an older year →
Your contract is pegged to an older year
Use the Medicare rates for the year named in your contract.
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Get rate-change alerts →
CMS publishes a new release
Get an email when your rates change.
Not every code runs through the RVU formula.
Medicare prices lab panels, anesthesia, and office visits through different schedules and formulas.
Clinical lab
Priced from the Clinical Laboratory Fee Schedule.
80053 · $10.56
National allowed amount
PUF_CLFS_CY2026_Q4V1.csv · row 649
Anesthesia
(Base units + time units) × the locality’s anesthesia conversion factor.
Capped imaging
For some imaging services, the hospital outpatient rate sets a ceiling. When it applies, that ceiling replaces the PFS formula.
Every source file and release is listed on the sources page.
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Don't build a CMS parser.
CMS changes column names, publishes RVUs instead of dollar amounts, and reissues files mid-quarter. One endpoint gives you the rate, release, and citations.
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curl --get 'https://localishealth.com/v1/rates/99213' \
-H 'Authorization: Bearer YOUR_API_KEY' \
--data-urlencode 'zip=90210' \
--data-urlencode 'setting=non_facility'Check one code. See the whole paper trail.
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