Public-domain federal data
What Medicare pays for 7,835 procedure codes.
The Centers for Medicare & Medicaid Services publishes a national-average reimbursement amount for every covered CPT and HCPCS code. We mirror it here, refreshed quarterly, with each code cross-linked to dispute scenarios where the same code commonly appears.
Have a code in mind?
Enter the 5-digit CPT or HCPCS code from your bill. We’ll show the Medicare benchmark and what it usually means.
ER & Emergency
ER visit codes (99281–99285) are the highest-volume billing-error pattern in the country. Levels 4 and 5 (99284, 99285) are the most upcoded. Knowing the federal benchmark is step one.
Office visits
Office E/M codes 99202–99215 cover most outpatient visits. The level chosen drives the dollar amount — and the level should match the documented complexity, not the time you remember spending in the waiting room.
- CPT 99202$77
Office visit, new patient, straightforward
- CPT 99203$120
Office visit, new patient, low complexity
- CPT 99204$182
Office visit, new patient, moderate complexity
- CPT 99205$242
Office visit, new patient, high complexity
- CPT 99213$98
Office visit, established patient, low complexity
- CPT 99214$139
Office visit, established patient, moderate complexity
- CPT 99215$197
Office visit, established patient, high complexity
Imaging
X-ray, CT, MRI, and ultrasound codes split into a technical component (the scan) and a professional component (the radiologist's read). The bill should match what was actually performed.
Lab & Pathology
Common labs paid under Medicare's Clinical Laboratory Fee Schedule. Watch for panels billed alongside their individual components — that's an unbundling pattern the National Correct Coding Initiative explicitly flags.
Drug J-codes
Per-unit Medicare rates for physician-administered drugs. The pharmaceutical-markup gap on consumer bills is highest in this category — saline at $3 per liter to Medicare can show up at $300+ on a chargemaster.
Common procedures
High-volume surgical codes — total knee, total hip, gallbladder, colonoscopy. The Medicare global package generally bundles pre-op and routine post-op care into the surgery payment.
- CPT 27447$1170
Total knee arthroplasty (knee replacement)
- CPT 27130$1173
Total hip arthroplasty (hip replacement)
- CPT 47562$635
Laparoscopic cholecystectomy (gallbladder removal)
- CPT 45378$390
Colonoscopy, diagnostic
- CPT 45385$515
Colonoscopy with polyp removal (snare)
- CPT 66984$474
Cataract surgery with IOL, one stage
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