Medicare Rate Calculator

ASCA provides the Medicare Rate Calculator, a members-only resource that clearly and easily shows your Medicare payment rates for ASC-payable procedures. By selecting your state and county from the drop-down menus, the calculator automatically finds your local wage index and calculates the total payment, Medicare payment and beneficiary copayment for each procedure. The calculator is made available when new rates are released by the Centers for Medicare & Medicaid Services (CMS), most notably in the summer for the proposed payment rule and in the fall for the final payment rule. New calculators are also posted for regular quarterly updates, as well as any ad hoc updates to the payment rates at other times.

2025 Final Rule

2025 Final Rule Rate Calculator

This calculator shows 2025 national and local ASC payment rates as published in the Centers for Medicare & Medicaid Services (CMS) CY 2025 OPPS/ASC final rule. 

As a reminder, CMS will issue a January payment addenda around January 1, 2025 which will contain official first quarter 2025 reimbursement rates. In particular, any drug prices included in this final rule calculator are NOT reflective of finalized rates, which will be released in the January addendum. There may also be a correction notice issued in early January 2025 which will contain slight modifications to rates.

Please note the following features of the rate calculator, which has changed slightly in the past year:

  • All codes are now included on the calculator. Please reference the "PI Definition" column for codes without a listed payment rate.
  • The calculator now displays the following national and locally adjusted rates:
    • Total payment (before and after sequestration)
    • Medicare payment (before and after sequestration)
    • The 2% sequester amount
    • The beneficiary copayment (which is not affected by the sequester).
  • The calculator allows users to format cells, columns and rows without affecting the calculator, UNLESS the columns with the state and county selector are hidden.
  • There are 15 columns located to the right of the calendar (highlighted in yellow) that are unlocked, should you wish to add custom filters, formulas or other adjustments.
  • Every column now includes a filter. The new and revised code column has also been altered to allow users to filter for new or revised codes specifically.

Please contact Alex Taira with any questions.