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.

2026 Final Rule

2026 Q1 Rate Calculator

This calculator shows Q1 2026 national and local ASC payment rates as published in the Centers for Medicare & Medicaid Services (CMS) January addenda. This calculator should be referenced for reimbursement rates related to procedures performed from January 1 to March 31, 2026.

Please note the following features of the rate calculator:

  • 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
    • 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.

2026 HOPD Rate Calculator

This calculator shows 2026 national and local hospital outpatient department (HOPD) payment rates as published in the Centers for Medicare & Medicaid Services (CMS) January Addendum B.

Please note the following features of the HOPD rate calculator:

  • The calculator only includes separately payable codes on Medicare's HOPD fee schedule (codes with a reimbursement rate)
  • You can apply or remove the 2% across-the-board sequester reimbursement reduction via the dropdown at the top