Reimbursement calculator
CPT Reimbursement Calculator
This calculator does simple, honest arithmetic on figures you supply: your contracted allowed amount per unit, the units, and the share you expect the payer to pay. It is deliberately not a fee schedule lookup. Fastora.
What this calculator shows
This calculator does simple, honest arithmetic on figures you supply: your contracted allowed amount per unit, the units, and the share you expect the payer to pay. It is deliberately not a fee schedule lookup. Fastora does not publish Medicare or commercial fee schedules here, because rates change, vary by locality and contract, and a stale rate quoted as fact would mislead you.
Use a recent remittance or your contract to get the allowed amount for the code. The CPT or HCPCS code box is for your reference on screen; the math does not depend on it.
Reimbursement calculator
CPT Reimbursement Calculator
Expected payment for a code, from your allowed amount and units.
How the calculation works
Total allowed = units x allowed amount per unit. Expected reimbursement = total allowed x expected payer percentage. Remaining share = total allowed - expected reimbursement.
How to read your result
If the expected figure surprises you, the interesting question is why: a wrong allowed amount in your system, a fee schedule that drifted from your contract, or units the payer bundles. Those are contract and remittance questions, covered by underpayment recovery and the underpayment calculator. For therapy units, our 8-minute rule guide explains how timed units are counted.
Looking for another measure? See all medical billing calculators or the formulas collected in our medical billing KPIs guide.
Before you rely on the number
Results are estimates for educational and operational planning, built from the figures you enter. They are not guarantees of reimbursement, savings or recovery, and they do not replace a review of your own claims, contracts and remittances. Do not enter patient-identifiable or protected health information: this calculator runs in your browser and nothing you type is stored or sent anywhere.
FAQ
Calculator questions
Still have a question? Talk to our team about your billing workflow.
Does this tool know Medicare rates?
No, and it does not claim to. Medicare rates vary by code, year and locality, and commercial rates come from your contract. Enter your allowed amount and the estimate follows from your real figures.
Why enter an expected payer percentage?
Because plans split the allowed amount between payer and patient differently. 100% models a payer paying the full allowed amount; 80% models a common split, with the rest as patient or secondary share.
What if the payer allows a different amount?
Then the claim paid to a different fee schedule than your system holds, which is an underpayment conversation. Compare the remittance against your contract.
Want this run on your real claims?
A free billing assessment reviews your actual denials, A/R and contracts, then gives you these numbers from your own data, in writing, before you decide anything.