How to look up a Medicare PT rate
Start with the CMS Physician Fee Schedule Look-Up Tool. Select the payment year, enter the applicable CPT or HCPCS code, and choose the locality for the service. Review the result and any payment indicators or policies that apply. Keep the code, year, locality, source, and date checked together so another person can reproduce the lookup.
Why locality and year matter
The tool provides payment information for services under the Physician Fee Schedule and can search by code and a specific Medicare Administrative Contractor (MAC) locality. CMS adjusts PFS pricing to reflect geographic practice-cost differences. A code’s amount can change between payment years, so a rate without its year and locality is incomplete.
The lookup has limits. CMS notes that MAC-priced codes and Medicare Part B non-payable codes are not displayed as standard PFS amounts. If a service is not priced there, use the applicable official Medicare file or MAC guidance rather than substituting an amount from another locality.
A fee-schedule amount is not a promised payment
The lookup is a reference, not a prediction of what a particular claim will pay. Setting, units, modifiers, coverage, claim edits, patient eligibility, and adjudication can affect the final result. When investigating a variance, compare the remittance with the correct year, code, locality, contract or policy, and claim details. Do not treat every difference as an underpayment.
See the CMS PFS tool overview for its scope and limits. This is general lookup guidance, not a guarantee of payment.