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Where and when

Name

Medicare payment locality

Where the service is performed. Sets the geographic adjustments (GPCIs) and which state's rules apply.

Date of service

Picks the fee schedule and NCCI quarter. Blank means today; a 2027 date uses next year's (projected) rates.

Place of service

Office Non-facility rates: the practice bears the overhead. Facility Hospital, ASC or SNF: the facility bills separately, the professional fee is lower.

Who bills and who pays

Payer

Traditional Medicare shows the 80/20 split and Medicare-only rules (WISeR, OPD prior auth).

Contracted rate

% of Medicare

100 for Medicare itself; e.g. 120 for a commercial contract at 120% of Medicare.

Billed by an NP or PA Medicare pays 85% of the physician rate. Qualifying APM participant Uses the higher QP conversion factor (2026 onward).

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