{"uid":"cap_XkiGRtrQ0el-RQ49jChy5","slug":"medicare-physician-fee-schedule-rate-lookup-43bebd97","name":"Medicare Physician Fee Schedule Rate Lookup","description":"What does Medicare pay for this CPT or HCPCS code at this ZIP? Physician Fee Schedule facility and non-facility allowed amounts with the RVUs and GPCIs behind them, any US ZIP or Medicare locality, 2025 on, computed by Distill from CMS’s quarterly RVU files. Updated quarterly. $0.01 per call (x402, USDC on Base); 3 free calls a day.","url":"https://data.spencermcw.com/v1/medicare/pfs/rate?utm_source=zero.xyz","method":"GET","headers":{},"bodySchema":{"type":"object","$schema":"https://json-schema.org/draft/2020-12/schema","required":["input"],"properties":{"input":{"type":"object","required":["type","method"],"properties":{"type":{"type":"string","const":"http"},"method":{"enum":["GET"],"type":"string"},"queryParams":{"type":"object","required":["code"],"properties":{"zip":{"type":"string","pattern":"^\\d{5}(-?\\d{4})?$"},"code":{"type":"string","pattern":"^[0-9A-Za-z]{5}$"},"date":{"type":"string","pattern":"^\\d{4}-\\d{2}-\\d{2}$"},"release":{"type":"string","pattern":"^\\d{4}[A-Da-d]$"},"setting":{"enum":["facility","nonfacility"],"type":"string"},"locality":{"type":"string","pattern":"^\\d{5}-\\d{2}$"},"modifier":{"type":"string","pattern":"^[0-9A-Za-z]{2}$"}}}},"additionalProperties":false},"output":{"type":"object","required":["type"],"properties":{"type":{"type":"string"},"example":{"type":"object","properties":{"data":{"type":"object","required":["code","modifier","code_type","description","status","status_meaning","priced","release","locality","location","rvus","gpci","conversion_factor","nonfacility","facility","indicators","history"],"properties":{"code":{"type":"string"},"gpci":{"type":"object"},"rvus":{"type":"object"},"priced":{"type":"boolean"},"status":{"type":"string"},"history":{"type":"array"},"release":{"type":"object"},"facility":{"anyOf":[{"type":"object"},{"type":"null"}]},"locality":{"type":"object"},"location":{"type":"object"},"modifier":{"type":["string","null"]},"code_type":{"enum":["CPT","HCPCS"],"type":"string"},"indicators":{"type":"object"},"description":{"type":["string","null"]},"nonfacility":{"anyOf":[{"type":"object"},{"type":"null"}]},"status_meaning":{"type":"string"},"conversion_factor":{"type":"object"}},"additionalProperties":false}}}}}}},"responseSchema":null,"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"0.01","displayCostAsset":"USDC","priceDynamic":false,"priceHint":null,"priceStatus":"priced","priceSource":"probe","requiresHandshake":false,"reviewCount":0,"rating":{"score":"0.00","successRate":"0.00","reviews":0,"stars":null,"state":"unrated"},"availabilityStatus":"unknown","priceObserved":null,"sessionDeposit":null,"pricing":{"kind":"static","summary":"$0.01/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_MR9aRFM7Z_iISNPJzwHJX","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"0.01","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Returns Medicare facility and non-facility allowed amounts for a CPT or HCPCS code at any US ZIP code or Medicare locality, including RVUs, GPCIs, and conversion factor details for 2025 onward.","exampleAgentPrompt":"What does Medicare pay for CPT code 99214 at ZIP 90210 in 2025 — give me both the facility and non-facility allowed amounts along with the RVUs and GPCIs behind them.","exampleUseCases":[{"title":"Verify reimbursement before accepting Medicare patient","prompt":"My practice is deciding whether to see Medicare patients for knee replacement (CPT 27447). What would Medicare pay for that procedure at our office in ZIP 60601 — both facility and non-facility rates — and what are the underlying RVUs?"},{"title":"Compare Medicare rates across localities","prompt":"I need to know the Medicare physician fee schedule rate for CPT 93000 (EKG) in ZIP 10001 in New York — show me the facility rate, non-facility rate, and the GPCIs used to calculate them."},{"title":"Medical billing audit for HCPCS code","prompt":"Can you pull the 2025 Medicare PFS allowed amount for HCPCS code G0439 (annual wellness visit) at ZIP 77001 in Houston, and tell me what status and indicators CMS has assigned to that code?"}],"resultDescription":"Returns a JSON object with the CPT or HCPCS code details including: facility and non-facility allowed amounts (or null if not applicable), RVU components (work, practice expense, malpractice), GPCI values for the resolved Medicare locality, the conversion factor used, locality and location metadata, code type (CPT or HCPCS), status and status meaning, description, indicators, the release quarter, and a history array of prior rates.","failureModes":["Invalid or unrecognized CPT/HCPCS code returns an error or unpriced result","ZIP code not mappable to a Medicare locality returns an error","Code exists but is not priced under the PFS (priced: false)","Release or date parameter outside supported range (2025 onward) may return no data","Malformed code format (not 5 alphanumeric characters) rejected by schema validation","Payment required after 3 free daily calls — must supply x402 USDC payment on Base"],"whenToPreferThis":"Use this endpoint when you need precise 2025+ Medicare Physician Fee Schedule allowed amounts for a specific procedure code at a specific US location, including the full RVU and GPCI breakdown. It is ideal for medical billing verification, practice revenue analysis, healthcare cost transparency tools, or any agent needing CMS-authoritative reimbursement data rather than estimates. Choose this over negotiated-rate or hospital price endpoints when the payer is specifically Medicare traditional (Part A/B) and the setting is physician/outpatient services rather than inpatient hospital.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-10-23T12:36:09.105Z","isFirstParty":false,"canonicalSlug":"medicare-physician-fee-schedule-rate-lookup-43bebd97"}