Methodology

Data Sources

All HCPCS Level II data on this site comes directly from the Centers for Medicare & Medicaid Services (CMS), which publishes the code set as a public domain resource. The primary sources are:

• HCPCS Release & Code Sets — The quarterly code file published by CMS at cms.gov, containing code identifiers, short descriptions, long descriptions, effective dates, and termination dates for all Level II codes.
• Medicare Physician Fee Schedule (PFS) — Annual fee schedule published by CMS, providing facility and non-facility payment rates by HCPCS code, GPCI-adjusted by locality.
• DMEPOS Fee Schedule — Quarterly fee schedule for durable medical equipment, prosthetics, orthotics, and supplies.
• NCCI Edits — Quarterly edit files published by CMS defining code pairs that cannot be billed together.
• NDC-HCPCS Crosswalk — CMS's mapping of National Drug Codes to HCPCS Level II codes, updated quarterly.

See Data Sources for direct links to CMS source files.

How CMS Sets Fee Schedule Rates

Physician Fee Schedule payment rates are calculated from three components multiplied together: Work Relative Value Units (RVUs), Practice Expense RVUs, and Malpractice RVUs. Each component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the provider's Medicare locality. The sum of adjusted RVUs is then multiplied by the annual conversion factor to produce the dollar payment amount.

Rates shown on this site are national averages — they do not reflect locality-specific adjustments. Actual payment to a specific provider depends on the Medicare Administrative Contractor (MAC) jurisdiction and applicable GPCI adjustments for that locality.

Quarterly Update Process

CMS updates HCPCS codes on January 1, April 1, July 1, and October 1 of each year. This site's ETL pipeline downloads and processes the quarterly code files when CMS releases them, typically several weeks before the effective date. The pipeline upserts data using the code identifier as the natural key — existing codes are updated in place; new codes are inserted; deleted codes are marked with a termination date.

The quarterly changes log on this site is generated from the change_type field in the code history table, which records each code's classification (added, revised, deleted) for each effective quarter.

Data Limitations

• Fee schedule rates shown are from the most recent data loaded into the system. If a quarterly update has been released by CMS but not yet processed by this site's ETL pipeline, rates may lag by up to one quarter.
• Locality-specific rate adjustments are not shown. Rates are national averages from the CMS national fee schedule file.
• CPT codes (Level I) are not included — they are AMA-copyrighted and outside the scope of this site.
• Coverage determinations (whether Medicare will pay for a specific service in a specific clinical scenario) are governed by National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which are not reflected in the code data shown here.
• This site is not affiliated with CMS or the federal government. Always verify rates and coverage policies directly with CMS or your Medicare Administrative Contractor.

Caching and Data Freshness

Individual code pages are cached for up to 24 hours. Search results and NDC lookup pages are not cached. After a quarterly ETL run, the cache is cleared to ensure fresh data is served. If you believe a code page is showing stale data, try appending a cache-busting parameter or contact the site administrator.