# Medicare Physician Fee Schedule Rate Lookup

> Medicare Physician Fee Schedule Rate Lookup is a paid API for AI agents from data.spencermcw.com, paid per call via x402, $0.01/call, status unknown (last checked 2026-10-23).

Returns Medicare facility and non-facility allowed amounts for a CPT or HCPCS code at any US ZIP code or Medicare locality, including RVUs, GPCIs, and conversion factor details for 2025 onward.

## Facts

- Endpoint: GET https://data.spencermcw.com/v1/medicare/pfs/rate?utm_source=zero.xyz
- Price: $0.01/call
- Payment: x402
- Status: unknown
- Last checked: 2026-10-23
- Activations on Zero: 0
- Tags: x402
- Canonical page: https://www.zero.xyz/c/medicare-physician-fee-schedule-rate-lookup-43bebd97
- Structured record (JSON): https://api.zero.xyz/v1/capabilities/cap_XkiGRtrQ0el-RQ49jChy5

Status and success rate cover calls made through Zero and Zero's own probes. Third-party monitors may report differently.

## How to call it through Zero

Zero handles the 402 payment challenge and records the run. With the Zero CLI installed (`npm i -g @zeroxyz/cli`):

```sh
zero fetch --capability medicare-physician-fee-schedule-rate-lookup-43bebd97
```

Example prompt: What does Medicare pay for CPT code 99214 at ZIP 90210 in 2025 — give me both the facility and non-facility allowed amounts along with the RVUs and GPCIs behind them.

## When to prefer this

Use this endpoint when you need precise 2025+ Medicare Physician Fee Schedule allowed amounts for a specific procedure code at a specific US location, including the full RVU and GPCI breakdown. It is ideal for medical billing verification, practice revenue analysis, healthcare cost transparency tools, or any agent needing CMS-authoritative reimbursement data rather than estimates. Choose this over negotiated-rate or hospital price endpoints when the payer is specifically Medicare traditional (Part A/B) and the setting is physician/outpatient services rather than inpatient hospital.

## Known failure modes

- Invalid or unrecognized CPT/HCPCS code returns an error or unpriced result
- ZIP code not mappable to a Medicare locality returns an error
- Code exists but is not priced under the PFS (priced: false)
- Release or date parameter outside supported range (2025 onward) may return no data
- Malformed code format (not 5 alphanumeric characters) rejected by schema validation
- Payment required after 3 free daily calls — must supply x402 USDC payment on Base

## How this service works

What does Medicare pay for this CPT or HCPCS code at this ZIP? Physician Fee Schedule facility and non-facility allowed amounts with the RVUs and GPCIs behind them, any US ZIP or Medicare locality, 2025 on, computed by Distill from CMS’s quarterly RVU files. Updated quarterly. $0.01 per call (x402, USDC on Base); 3 free calls a day.

## Output

Returns a JSON object with the CPT or HCPCS code details including: facility and non-facility allowed amounts (or null if not applicable), RVU components (work, practice expense, malpractice), GPCI values for the resolved Medicare locality, the conversion factor used, locality and location metadata, code type (CPT or HCPCS), status and status meaning, description, indicators, the release quarter, and a history array of prior rates.

## Request schema (JSON Schema)

```json
{
 "type": "object",
 "$schema": "https://json-schema.org/draft/2020-12/schema",
 "required": [
  "input"
 ],
 "properties": {
  "input": {
   "type": "object",
   "required": [
    "type",
    "method"
   ],
   "properties": {
    "type": {
     "type": "string",
     "const": "http"
    },
    "method": {
     "enum": [
      "GET"
     ],
     "type": "string"
    },
    "queryParams": {
     "type": "object",
     "required": [
      "code"
     ],
     "properties": {
      "zip": {
       "type": "string",
       "pattern": "^\\d{5}(-?\\d{4})?$"
      },
      "code": {
       "type": "string",
       "pattern": "^[0-9A-Za-z]{5}$"
      },
      "date": {
       "type": "string",
       "pattern": "^\\d{4}-\\d{2}-\\d{2}$"
      },
      "release": {
       "type": "string",
       "pattern": "^\\d{4}[A-Da-d]$"
      },
      "setting": {
       "enum": [
        "facility",
        "nonfacility"
       ],
       "type": "string"
      },
      "locality": {
       "type": "string",
       "pattern": "^\\d{5}-\\d{2}$"
      },
      "modifier": {
       "type": "string",
       "pattern": "^[0-9A-Za-z]{2}$"
      }
     }
    }
   },
   "additionalProperties": false
  },
  "output": {
   "type": "object",
   "required": [
    "type"
   ],
   "properties": {
    "type": {
     "type": "string"
    },
    "example": {
     "type": "object",
     "properties": {
      "data": {
       "type": "object",
       "required": [
        "code",
        "modifier",
        "code_type",
        "description",
        "status",
        "status_meaning",
        "priced",
        "release",
        "locality",
        "location",
        "rvus",
        "gpci",
        "conversion_factor",
        "nonfacility",
        "facility",
        "indicators",
        "history"
       ],
       "properties": {
        "code": {
         "type": "string"
        },
        "gpci": {
         "type": "object"
        },
        "rvus": {
         "type": "object"
        },
        "priced": {
         "type": "boolean"
        },
        "status": {
         "type": "string"
        },
        "history": {
         "type": "array"
        },
        "release": {
         "type": "object"
        },
        "facility": {
         "anyOf": [
          {
           "type": "object"
          },
          {
           "type": "null"
          }
         ]
        },
        "locality": {
         "type": "object"
        },
        "location": {
         "type": "object"
    
… (truncated)
```

## More

- Live health (JSON, refreshed every minute): https://www.zero.xyz/c/medicare-physician-fee-schedule-rate-lookup-43bebd97/health.json
- [Zero catalog index](https://www.zero.xyz/llms.txt)
- [Other services from data.spencermcw.com](https://www.zero.xyz/host/data.spencermcw.com/llms.txt)