Browse Medicare Physician Fee Schedule guidance for payment rates, RVUs, global periods, modifier indicators, geographic adjustments, and billing rules.

Medicare Physician Fee Schedule Lookup Guide

How to Use the CMS PFS Look-Up Tool

Learn how to use the Medicare Physician Fee Schedule Look-Up Tool to check payment rates, RVUs, global surgery periods, modifier indicators, and other Medicare billing information.

The Medicare Physician Fee Schedule (PFS) Look-Up Tool is an official CMS resource for researching Medicare payment information for more than 10,000 services.

Medical billers, coders, physicians, and practice staff can use the tool to research Medicare pricing, Relative Value Units (RVUs), payment policy indicators, geographic adjustments, and whether certain billing rules apply to a CPT or HCPCS code.

Open the Official CMS Physician Fee Schedule Look-Up Tool

What Is the Medicare Physician Fee Schedule?

The Medicare Physician Fee Schedule is used by Medicare to determine payment for many services furnished by physicians and other healthcare professionals.

Rather than assigning every service a simple nationwide dollar amount, Medicare calculates PFS payments using factors that account for the resources required to provide the service and geographic differences in practice costs.

The CMS PFS Look-Up Tool allows users to research this information by CPT or HCPCS code and examine the payment policies associated with individual services.

What Can You Find in the PFS Look-Up Tool?

Medicare Payment Amounts: Review national or locality-specific fee schedule amounts for eligible services.

Facility and Non-Facility Rates: Compare payment amounts based on the setting in which a service is furnished.

Professional and Technical Components: Determine whether professional and technical component rules apply to a code.

Global Surgery Days: Check the postoperative period associated with a surgical procedure.

Multiple Surgery Indicators: Determine which Medicare multiple-procedure payment rules apply.

Bilateral Surgery Indicators: Check whether Medicare's bilateral surgery payment rules apply to a procedure.

Assistant-at-Surgery Indicators: Determine whether Medicare allows payment for an assistant at surgery.

Physician Supervision: Review applicable supervision requirements for diagnostic services.

Relative Value Units: Research work, practice expense, and malpractice RVUs.

Geographic Adjustments: Review Geographic Practice Cost Index information used to adjust Medicare payments by locality.

How to Search the Medicare Physician Fee Schedule

1. Select the Year

Choose the Medicare Physician Fee Schedule year you want to research.

Using the correct year matters because CMS updates PFS information over time, including payment rates and policy information.

2. Choose the Type of Information

CMS currently provides several search options:

Pricing Information
Payment Policy Indicators
Relative Value Units (RVUs)
Geographic Practice Cost Index (GPCI)
All

Choose the option that matches the information you need rather than automatically selecting pricing.

3. Enter the CPT or HCPCS Code

The tool allows searches using a single HCPCS code, a list of codes, or a range of codes.

CMS notes that the PFS includes both Level I CPT codes and Level II HCPCS codes.

4. Select the Modifier When Applicable

For pricing searches, CMS provides modifier selections that include:

Global service
Modifier 26
Modifier 53
Modifier TC
All Modifiers

Selecting All Modifiers can be useful when you are unsure whether the code has separately priced professional or technical components.

Importantly, "All Modifiers" in this tool does not mean every CPT or HCPCS modifier. It refers to the modifier options supported within the PFS pricing search.

5. Choose the Medicare Location

For applicable searches, you can select a national payment amount, specific Medicare Administrative Contractor (MAC), specific locality, or all MACs.

This matters because Medicare PFS payment amounts can vary geographically.

How to Check Whether Modifier 26 or TC Applies

One of the most useful features of the PFS tool for ModifierLookup users is the Professional Component/Technical Component (PC/TC) indicator.

Choose Payment Policy Indicators and search the applicable CPT or HCPCS code.

The PCTC field indicates how professional and technical component rules apply to that service.

For eligible diagnostic services, separate results may be available for:

Modifier 26: Professional component.

Modifier TC: Technical component.

No Modifier: Global service when the same billing entity appropriately furnishes both components.

CMS's own example demonstrates a service that can be reported globally or divided between Modifier 26 and TC.

How to Check a Procedure's Global Period

Select Payment Policy Indicators and search for the procedure.

Locate the Global field in the results.

For applicable surgical procedures, this field identifies the global surgery period associated with the code. For example, CMS explains that an indicator of 090 represents a major surgery with a 1-day preoperative period and a 90-day postoperative period included in the fee schedule payment.

Global-period information is particularly important when determining whether postoperative modifiers such as 24, 57, 58, 78, or 79 may apply.

How to Check Bilateral Surgery Rules

Look for the BILT SURG field under Payment Policy Indicators.

This indicator helps determine how Medicare's bilateral surgery payment rules apply to the procedure.

This information can be important before reporting Modifier 50 or applicable anatomical modifiers such as LT and RT.

Do not assume that every procedure performed bilaterally should automatically be reported with Modifier 50. Check the applicable code and payer rules first.

How to Check Assistant-at-Surgery Rules

The ASST SURG indicator shows whether Medicare's assistant-at-surgery payment restrictions apply to a particular procedure.

This information can help determine whether assistant-at-surgery services may qualify for Medicare payment before reporting modifiers such as 80, 81, or 82.

CMS specifically identifies assistant-at-surgery payment as one of the policies users can research through the PFS Look-Up Tool.

How to Check Multiple Surgery Rules

The MULT SURG field identifies which multiple-procedure payment rules apply to a service.

This is important when multiple procedures are performed during the same operative session because Medicare payment adjustments may apply to certain combinations of services.

The indicator should be interpreted according to the current Medicare PFS definitions rather than assuming that every additional procedure automatically receives the same payment adjustment.

Understanding Facility vs. Non-Facility Rates

The PFS may display separate facility and non-facility payment amounts.

A non-facility setting commonly includes a physician office where the practice bears expenses such as clinical staff, equipment, and supplies.

A facility setting can include locations such as hospitals and ambulatory surgical centers, where those resources may be supplied by the facility.

Because the practice expenses differ, the Medicare payment amounts for the physician's service can also differ.

Understanding RVUs

Relative Value Units help determine the relative resources associated with Medicare PFS services.

The PFS uses three primary RVU components:

Work RVU: Reflects the relative time and intensity required to furnish the service.

Practice Expense RVU: Reflects practice costs such as staff, equipment, supplies, and office expenses.

Malpractice RVU: Reflects relative professional liability insurance costs.

These components contribute to the calculation of Medicare PFS payment rates.

Understanding GPCIs

Medicare uses Geographic Practice Cost Indices (GPCIs) to account for geographic differences in the costs of practicing medicine.

Separate geographic adjustments apply to the work, practice expense, and malpractice components of the RVU calculation.

This is one reason Medicare payment for the same service can differ depending on the geographic payment locality.

Common PFS Look-Up Mistakes

Using the Wrong Year: Payment amounts and policy information can change, so make sure you are reviewing the intended PFS year.

Looking Only at Price: Payment Policy Indicators can reveal important information about global periods, modifiers, bilateral surgery, assistant-at-surgery rules, and supervision.

Assuming Every Code Accepts Modifier 26 or TC: Professional and technical component billing applies only when supported by the code's payment rules.

Ignoring Locality: Medicare payment amounts can vary geographically.

Misreading All Modifiers: The PFS search option does not represent every possible CPT and HCPCS modifier.

Treating the Tool as a Coverage Guarantee: A fee schedule amount or payment indicator does not by itself establish that every claim is covered or payable.

Important PFS Limitation

The CMS PFS Look-Up Tool is an aid for researching Physician Fee Schedule information. CMS notes that it does not display MAC-priced codes or Medicare Part B non-payable codes and directs users to their Medicare Administrative Contractor for official definitive payment information when necessary.

CMS also updates PFS information periodically, so users should verify that they are viewing the appropriate year and current information.

Frequently Asked Questions

Can I use the Medicare Physician Fee Schedule to determine whether Modifier 26 or TC applies?
Yes. The Payment Policy Indicators include professional/technical component information. CMS's PFS examples demonstrate how eligible codes may display separate global, Modifier 26, and Modifier TC information.

Does finding a Medicare payment amount mean the claim will automatically be paid?
No. Actual payment can still depend on coverage, medical necessity, coding, modifier use, provider status, claim information, and other Medicare requirements.