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Medicare PFS Reference Lookup

Calculate a supported base reference from CMS October 2026 RVUs and locality data, inspect its source and compare a contract percentage.

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FROM SOURCE TO COMPARISON

Try a Medicare reference lookup.

Run a supported example from the imported CMS snapshot. You will see the selected locality, calculation components and the separate 125% comparison.

1. Choose the basis

Service date, code, component, setting, rate class and geography.

2. Inspect the reference

The result includes the source rows and calculation components.

3. Compare the terms

Apply the contract percentage separately. It is not a determination of the final payment.

Enter a different reference →

Checking source availability. No example rate is substituted if the snapshot cannot be used.

CMS OCTOBER 2026 SNAPSHOT

Choose the service and reference basis.

Checking the imported source

Checking the local snapshot. No amount is substituted when a source or required field is missing.

Choose the reference
Only the imported Q4 2026 release is available.
October 1–December 31, 2026.
One code. Descriptions are not included in this version.
Other modifiers are not applied by this tool.
This selects the practice-expense basis.
Check which basis applies. We cannot establish QP eligibility.
The unadjusted reference is not an average of local prices.
Do not enter a patient’s address. Some ZIPs require all nine digits.
100 shows the base. 125 multiplies it by 1.25.

Your query is sent to DueMD’s lookup API. Code, ZIP and financial values are not sent to analytics or retained as lookup history.

Source snapshot and provenance

What is included and excluded · Dataset versions · Official CMS lookup ↗

What the tool calculates

For a supported single service, we multiply the work, practice-expense and malpractice RVUs by the matching geographic indices, add them, then apply the conversion factor from the chosen QP/non-QP source file. We round that base reference to cents before applying your contract percentage.

For an unadjusted national reference, each geographic index is explicitly set to 1. That is a separate reference assumption, not a national weighted average or a value read from a complete national payment table.

Unsupported calculations

We do not calculate an amount for a setting marked NA, a contractor-priced or bundled status, anesthesia, an unsupported modifier or a row with an OPPS-cap dependency. A split ZIP needs ZIP+4. No nearby code, default locality or different rate class is used to fill a gap.

What a reference does not tell you

A base reference does not establish coverage or what a payer owes. It does not apply all claim-level rules, multiple-procedure reductions, beneficiary responsibility, sequestration, MIPS or other payment adjustments. Check the terms of the contract before using the percentage comparison.

Compare like with like · What 110% of Medicare means · Method M-MB-001 · v2.0.0

Already have a reference amount?

This worksheet checks only your multiplication. It does not verify the reference against the CMS files.

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