BILLING Intelligence
Know before you bill.
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CPT Lookup
CPT & Rate Lookup
Search 19,226 active Medicare codes — rate, operative time, modifiers, and medical necessity.
Look up any Medicare CPT — rate, operative time, modifiers, and what you must document — before you bill.
1Search a code or describe the procedure.
2Open a row for rate, time & modifier actions.
3Check the medical-necessity language so it pays.
Locality ZIP Defaults to national average if not entered ZIP not found
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Global Period
Global Period Calculator
Enter surgery date + CPT codes to see what's included in the global package vs. separately billable.
Know exactly what's bundled into the surgical global — and what you can still bill separately.
1Enter the surgery date + CPT codes.
2See the global-period length per code.
3Check what's included vs separately billable.

Global periods follow the 2026 CMS fee schedule; some payers use their own. Not a coverage decision. For planning and informational purposes only. Results are estimates from public data and general rules; real results vary by plan, payer, state and records. Not billing, legal, coding or financial advice, and not a guarantee of payment or reimbursement. Always check with the payer and the patient’s plan before acting. You are responsible for checking any result before you rely on it. Auctus makes no warranty about the accuracy or completeness of these estimates. Terms.

Medical Necessity
Medical Necessity & Policy Intelligence
Documentation checklists · payer policy links · denial-risk flags.
Get paid the first time — the exact documentation each payer's policy requires, before you submit.
1Search the procedure.
2Work the documentation checklist.
3Clear the LCD-watch denial-risk flags.
Specialty
Type
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Patient Liability
Patient Liability Estimator
Estimate what the patient owes. Uses live Medicare rates, or type your payer’s allowed amount.
Tell patients what they'll owe before the visit — copay, deductible & coinsurance on live Medicare rates or your payer’s allowed amount.
1Enter the CPT code.
2Add the patient's benefit status.
3See the estimated patient responsibility.
Place of Service
$
Leave blank to use the Medicare rate for the codes above.
Patient Benefit Status
$
$
$
%
$
$

Medicare Part B defaults: 2026 deductible $257 · 20% coinsurance · No statutory OOP max. Allowable adjusted by GPCI locality when ZIP entered. If you type an allowed amount, it replaces the Medicare rate and no locality adjustment applies. Planning estimates only — not for use in billing or collections.

What the patient owes depends on their plan’s deductible, coinsurance and allowed amount. For planning and informational purposes only. Results are estimates from public data and general rules; real results vary by plan, payer, state and records. Not billing, legal, coding or financial advice, and not a guarantee of payment or reimbursement. Always check with the payer and the patient’s plan before acting. You are responsible for checking any result before you rely on it. Auctus makes no warranty about the accuracy or completeness of these estimates. Terms.

Your practice
people
$/hr
$/mo
Billing Savings
What is in-house billing really costing you?
Three numbers. See what outsourcing could save you each month.

Estimate for advertising purposes only. Actual results vary. Your custom quote is based on your specialty, payer mix and volume.

Your real savings depend on your specialty, payers and volume. For planning and informational purposes only. Results are estimates from public data and general rules; real results vary by plan, payer, state and records. Not billing, legal, coding or financial advice, and not a guarantee of payment or reimbursement. Always check with the payer and the patient’s plan before acting. You are responsible for checking any result before you rely on it. Auctus makes no warranty about the accuracy or completeness of these estimates. Terms.

Breast Reduction
Will the case meet the Schnur minimum?
Height and weight give the minimum tissue per breast most payers expect for CPT 19318.

Body surface area uses the DuBois formula. Minimums follow the Schnur sliding scale (Schnur et al., 1991), straight-line between the published 0.05 m² rows; below 1.35 m² the 199 g floor applies, above 2.55 m² the 1,662 g top row. Payers differ: some use a flat 500 g per breast or cap the scale at 1,000 g above 2.30 m² (Aetna). Check the patient’s plan policy. Estimate only, not a coverage decision.

Payers use different minimums; check the patient’s plan policy. For planning and informational purposes only. Results are estimates from public data and general rules; real results vary by plan, payer, state and records. Not billing, legal, coding or financial advice, and not a guarantee of payment or reimbursement. Always check with the payer and the patient’s plan before acting. You are responsible for checking any result before you rely on it. Auctus makes no warranty about the accuracy or completeness of these estimates. Terms.

IDR Check
Is this claim worth taking to IDR?
Check if it qualifies and whether it’s worth filing.
Codes on the claim
One row per line on the EOB. Each code counts at full value. $0 paid is fine if the EOB shows an allowed amount for the code (for example, it went to the deductible). A flat denial with no allowed amount isn’t an IDR claim yet. Appeal it first.
How will these codes be filed?
Separately means fees on every code. Together means one set of fees for the claim.
$0 is fine if it went to the deductible. If it was denied because an assistant isn’t allowed on this code, appeal it first.

How it works: typical awards come from past federal IDR results (CMS public use file), shown as a multiple of the QPA for each code. Without an EOB QPA, the QPA is estimated from the 2026 Medicare rate for the ZIP. Bilateral counts double; a PA or NP assistant claim is 13.6% of the surgeon’s rate. We handle the filing fees, so they don’t change the answer. State rules: CMS applicability chart. “Worth filing” means about $3,000 or more in billed charges, where IDR usually pays clearly more than the plan did; borderline is $2,000 to $3,000. The line is a guide, not a rule. Each paid code is priced as its own filing unless you choose to file them together.

Billing IQ by The Auctus Group · Terms · Privacy · estimates only
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