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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
MAC
Defaults to national average if not entered
ZIP not found
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PE:
MP:
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| CPT | Description | Nat'l Rate | Office |
|---|---|---|---|
Place of Service
| CPT | Description | Nat'l Rate | Facility Rate | Office Rate | Global | MUE | ||
|---|---|---|---|---|---|---|---|---|
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natl avg
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natl avg
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Surgical Rules
MUE
maximum units / day
No MUE edit on file
Quick Bundle Check
Does bundle with:
✓ No edit
Global Period
Included
Separately Billable
Time & $/Hour
| per session, not per unit/lesion
| commercial benchmark
$/hr = Medicare (CMS) allowed at this ZIP, in-network floor. Commercial & OON run higher. Benchmark ≈ 1.1× Medicare.
Modifier Actions
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Knowing the rate is step one. Collecting it is the fight.
Showing first 20 — refine your search to narrow results
No active codes found for ""
Search 19,226 active Medicare CPT codes
Try a code like 11400, a procedure like lesion removal, or specialty like anesthesia podiatry
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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.
| CPT | Description | Global | Period Ends | Rate | |
|---|---|---|---|---|---|
|
✓ Included in Global
Separately Billable
Key Modifiers
-24 Unrelated E&M in global
-58 Staged/related procedure -78 Return to OR for complication -79 Unrelated procedure in global |
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90 days of follow-ups you can't bill — unless it's coded right.
Search a procedure above to start tracking global periods.
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.
Patient Liability
Patient Liability Estimator
Estimate Medicare Part B patient responsibility using live MPFS allowables.
Tell patients what they'll owe before the visit — copay, deductible & coinsurance on live Medicare rates.
1Enter the CPT code.
2Add the patient's benefit status.
3See the estimated patient responsibility.
Place of Service
50%
Total Medicare Allowed
Modifier Check
Checking NCCI edits…
+
🚫 Hard Bundle
⚠ Add Mod 59
✓ Clean
Modifier 59 (or X{EPSU}) indicates a distinct procedural service. Required when two codes are bundled under NCCI but performed at a separate site, session, or incision. Document clearly in the operative note.
Hard bundles cannot be separately billed regardless of modifier. The column 2 code is considered included in the column 1 code per NCCI policy.
Related — click to add
Patient Benefit Status
$
$
$
%
$
$
Add a CPT code, enter benefit details, then Calculate
Supports multiple codes, bilateral modifier, and multi-proc reductions
Estimated Patient Liability
OOP maximum applied
Breakdown
| Medicare Allowed | |
| Step 1 — Copay | |
| Step 2 — Deductible | |
| Pre-cap subtotal | |
| Patient Owes |
Collect this before the visit — it's three times harder after.
Remaining After This Claim
Deductible remaining
OOP remaining
OOP Max
No cap
Medicare Part B defaults: 2026 deductible $257 · 20% coinsurance · No statutory OOP max. Allowable adjusted by GPCI locality when ZIP entered. Planning estimates only — not for use in billing or collections.