gardencalculator.net

Medicare Payment Calculator

Enter the three RVU components, your locality’s GPCIs and the conversion factor to estimate the Medicare fee-schedule payment.

Written by Jude Ramsey · Last updated August 2026 · How these calculators are checked

How the fee schedule builds a payment

Every Medicare physician payment is the same machine: three RVU components — work, practice expense and malpractice — each adjusted by its locality’s GPCI, summed, and multiplied by the year’s conversion factor. Enter the values from the published fee-schedule files for your code and locality, and this calculator assembles the estimate with each component’s share shown.

How to use it

  1. Enter the work, PE and MP RVUs for the code (PE differs by facility vs non-facility setting — use the one that matches).
  2. Enter the three GPCIs for your locality (1.0 if unadjusted).
  3. Enter the conversion factor for the year.

The formula

payment = (wRVU×wGPCI + peRVU×peGPCI + mpRVU×mpGPCI) × CF

A worked example

Work 1.92, PE 1.70, MP 0.14 at neutral GPCIs totals 3.76 RVUs — at a $32.35 conversion factor, $121.64. Switch the PE to a facility value of 0.85 and the same service in a hospital setting drops to about $94 — the site-of-service differential in one keystroke, and the reason the facility/non-facility distinction matters on every claim.

Estimates only — payer contracts, plan documents, published fee schedules and the EOB are the source of truth, and nothing here is billing, legal or medical advice. The calculator runs entirely in your browser: no patient data is entered, transmitted or stored.

Common questions

Why do facility and non-facility pay differently?
The practice-expense RVU shrinks in a facility because the hospital — not the physician practice — bears the overhead and bills its own facility fee alongside.
Where do RVUs, GPCIs and the CF come from?
The published physician fee schedule files — updated annually (and sometimes mid-year for the CF). Always match all inputs to the same year.
Is the result what the practice actually receives?
It’s the allowed amount basis — the patient’s Part B coinsurance (typically 20%) splits out of it, and sequestration or participation status can shave the paid figure.

Related calculators

RVU calculatorMedical Billing calculatorCoinsurance calculatorDRG Payment calculator