Payment Calculator

Interactive RVU/GPCI payment calculator — see expected Medicare reimbursement for any CPT at any facility

Paste a CCN and CPT. See the math. Free.

The Payment Calculator is RCI’s public tool for estimating Medicare reimbursement. Enter a facility and procedure code — get the full MPFS breakdown with GPCI adjustments.

Try it at rcintell.com/tools

How it works

Enter:

• CCN — the facility’s Medicare Provider Number (e.g., 170001)
• CPT — the procedure code (e.g., 99213)

Get:

CCN: 170001 (Sunflower Medical Center, Kansas)
CPT: 99213 (Office/outpatient visit, established, low complexity)

┌─────────────────────────────────────────────────────┐
│  Component     │  RVU    │  GPCI   │  Adjusted      │
│────────────────│─────────│─────────│────────────────│
│  Work          │  1.30   │  1.000  │  1.300         │
│  PE (facility) │  0.99   │  0.891  │  0.882         │
│  Malpractice   │  0.10   │  0.407  │  0.041         │
│────────────────│─────────│─────────│────────────────│
│  Total         │  2.39   │         │  2.223         │
└─────────────────────────────────────────────────────┘

Conversion Factor (2026): $32.35

Estimated Payment:  $71.91 (facility rate)
                    $100.53 (non-facility rate)

Features

• Facility vs non-facility — toggle to see both rates
• GPCI breakdown — see how geography affects each component
• Year selector — compare across conversion factor years
• Share link — generate a URL to share a specific calculation
• Bulk mode — paste multiple CPT codes, get a fee schedule for a facility
• Compare facilities — side-by-side comparison of the same CPT at two locations

Use cases

Who	Why they use it
Billers	Verify expected payment before submission
Providers	Estimate reimbursement for patient cost conversations
Contract negotiators	Benchmark payer rates against MPFS
Payer analysts	Validate fee schedule accuracy
Students	Learn how Medicare payment works

Formula

Payment = (Work RVU × Work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × CF

Where:

• RVU = Relative Value Units from the CMS MPFS Relative Value File
• GPCI = Geographic Practice Cost Index for the facility’s location
• CF = Conversion Factor ($32.35 for 2026)
• PE RVU = facility or non-facility rate depending on care setting

API equivalent

curl -X POST https://api-dev.rcintell.com/v1/knowledge/payment-calc \
  -H "X-API-Key: kp_test_..." \
  -H "Content-Type: application/json" \
  -d '{"ccn": "170001", "cpt": "99213"}'

Free to use

The Payment Calculator is free at rcintell.com/tools. No account required. API access for programmatic use requires a free API key.