Calculate expected payment
Calculate expected Medicare payment for a service at a facility.
Same four-block composition as GET /v1/codes/{code}/payment (physician /
OPPS / CLFS / DMEPOS) via shared payment_math. estimated_payment and
components remain the physician (MPFS) view for existing clients.
modifier, place_of_service, and qpp are forwarded to the composer.
Authorizations
Body
Calculate expected Medicare payment for a service at a facility.
6-digit Medicare Provider Number
^\d{6}$"170001"
CPT procedure code
^[A-Za-z0-9]{5}$"99213"
CPT modifier (e.g. 26, TC)
Payer (defaults to Medicare; unused by fee-schedule math)
Place of service code
"11"
Use QPP conversion factor (True) or non-QPP (False)
Response
Payment estimate with RVU/GPCI breakdown
Payment calculation result — same four blocks as GET /v1/codes/{code}/payment.
estimated_payment and components remain the physician (MPFS) view for
existing clients. applicable_blocks plus physician / outpatient_facility
/ lab / dme are the calculator-parity composition.
Queried CCN
Queried CPT code
Physician MPFS breakdown: RVUs, GPCI values, conversion factor
DMEPOS payment — picks rural vs non-rural rate by facility flag.
Physician (MPFS) allowed amount in USD
Facility context used to drive payment composition.
Clinical Lab Fee Schedule payment (national rate, no geographic adjustment).
Payment calculation methodology description
OPPS / outpatient hospital facility payment block.
payment = (rate * 0.6 * wage_index) + (rate * 0.4)
MPFS payment block — work + PE + MP, GPCI-adjusted, then * conversion factor.
User-visible reliability metadata for this payment composition.