> ## Documentation Index
> Fetch the complete documentation index at: https://docs.oneshotagent.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Medicare Fee Schedule
> Look up national Medicare Physician Fee Schedule relative value units and payment amounts for a procedure code.
Returns the status indicator, relative value units, conversion factors and national payment amounts, before the locality adjustment, on Medicare's physician payment schedule for a procedure code and modifier. Non-facility is an office, where the practice bears the overhead; facility is a hospital or other facility paid separately for it. Codes and amounts only; procedure descriptions are licensed and not returned.
## Authentication
Requires x402 payment in the `payment-signature` header.
## Request Body
**code** `string` *required*
Five-character procedure code, for example 99213 or G0439. five letters or digits.
**modifier** `string`
Two-character modifier, for example 26 or TC; without it, rows with no modifier are returned. two letters or digits.
**year** `integer`
Calendar year of the schedule; defaults to the newest published year. From 2025 to 2026. Defaults to `2026`.
## Response (200 OK)
Top-level envelope: `success` (boolean) and `data` (object). All fields below are nested under `data`.
**data.request\_id** `string`
Durable job ID for audit and lookup
**data.status** `string`
Job status: `completed`
**data.tool** `string`
Always `market_medicare_fees`
**data.result** `object`
The answer, described under Result below
**data.evidence** `object`
Where the answer came from and when
**data.evidence.source** `string`
The public body the data comes from. Always `US Centers for Medicare & Medicaid Services`.
**data.evidence.source\_kind** `string`
`public` when the data comes from a public body, `commercial` otherwise
**data.evidence.retrieved\_at** `string`
When the lookup was made, as an ISO 8601 UTC time
**data.evidence.as\_of** `string | null`
The amounts are for the calendar year given. The source rows carry no date, so as\_of is null.
## Result
Nested under `data.result`.
**data.result.code** `string`
The procedure code looked up, upper-cased.
**data.result.year** `integer`
Calendar year of the schedule.
**data.result.status** `string | null`
Source status indicator, for example A for an active code; null when the code is not on the schedule for the year.
**data.result.status\_meaning** `string | null`
What the status indicator means; null when the source does not document it.
**data.result.rates** `object[]`
One entry per conversion factor the year uses, for the requested modifier; empty when there is no match.
**data.result.rates\[].modifier** `string | null`
Two-character modifier; null for the unmodified code.
**data.result.rates\[].conversion\_factor\_usd** `number`
US dollars per relative value unit for this rate.
**data.result.rates\[].rvu\_work** `number`
Work relative value units.
**data.result.rates\[].rvu\_practice\_expense\_non\_facility** `number | null`
Practice expense relative value units outside a facility; null when the source marks it not applicable.
**data.result.rates\[].rvu\_practice\_expense\_facility** `number | null`
Practice expense relative value units in a facility; null when the source marks it not applicable.
**data.result.rates\[].rvu\_malpractice** `number`
Malpractice relative value units.
**data.result.rates\[].rvu\_total\_non\_facility** `number | null`
Total relative value units outside a facility; null when not applicable.
**data.result.rates\[].rvu\_total\_facility** `number | null`
Total relative value units in a facility; null when not applicable.
**data.result.rates\[].national\_payment\_non\_facility\_usd** `number | null`
Total non-facility relative value units times the conversion factor, rounded to cents: the national amount before the geographic locality adjustment; null when not applicable or when the contractor sets the payment (status C or L).
**data.result.rates\[].national\_payment\_facility\_usd** `number | null`
Total facility relative value units times the conversion factor, rounded to cents: the national amount before the geographic locality adjustment; null when not applicable or when the contractor sets the payment (status C or L).
**data.result.rates\[].global\_days** `string`
Global surgery period: 000, 010 or 090 days; XXX when the concept does not apply; YYY set by the contractor; ZZZ for an add-on code; MMM for maternity.
**data.result.rates\[].label** `string`
Who this conversion factor applies to.
```bash cURL theme={null}
curl -X POST https://win.oneshotagent.com/v1/tools/lookup/market-medicare-fees \
-H "Content-Type: application/json" \
-H "payment-signature: " \
-d '{
"code": "99213"
}'
```
```javascript JavaScript theme={null}
const response = await fetch("https://win.oneshotagent.com/v1/tools/lookup/market-medicare-fees", {
method: "POST",
headers: {
"Content-Type": "application/json",
"payment-signature": paymentProof,
},
body: JSON.stringify({
"code": "99213"
}),
});
```
```typescript SDK theme={null}
const result = await agent.tool('lookup/market-medicare-fees', {
code: '99213'
});
console.log(result.result);
console.log(result.evidence);
```
```json Response (200) theme={null}
{
"success": true,
"data": {
"request_id": "uuid",
"receipt_id": "rcpt_...",
"status": "completed",
"tool": "market_medicare_fees",
"result": {
"code": "99213",
"year": 2026,
"status": "A",
"status_meaning": "Active code: paid separately under the physician fee schedule when covered",
"rates": [
{
"modifier": null,
"conversion_factor_usd": 33.5675,
"rvu_work": 1.3,
"rvu_practice_expense_non_facility": 1.46,
"rvu_practice_expense_facility": 0.33,
"rvu_malpractice": 0.09,
"rvu_total_non_facility": 2.85,
"rvu_total_facility": 1.72,
"national_payment_non_facility_usd": 95.67,
"national_payment_facility_usd": 57.74,
"global_days": "XXX",
"label": "qualifying alternative payment model participants"
},
{
"modifier": null,
"conversion_factor_usd": 33.4009,
"rvu_work": 1.3,
"rvu_practice_expense_non_facility": 1.46,
"rvu_practice_expense_facility": 0.33,
"rvu_malpractice": 0.09,
"rvu_total_non_facility": 2.85,
"rvu_total_facility": 1.72,
"national_payment_non_facility_usd": 95.19,
"national_payment_facility_usd": 57.45,
"global_days": "XXX",
"label": "all other clinicians"
}
]
},
"evidence": {
"source": "US Centers for Medicare & Medicaid Services",
"source_kind": "public",
"retrieved_at": "2026-01-15T12:00:00.000Z",
"calls": [
{
"retrieved_at": "2026-01-15T12:00:00.000Z"
}
],
"as_of": null
}
}
}
```
> [!NOTE]
>
> See [Pricing](https://docs.oneshotagent.com/pricing.md) for this tool's price. A wallet (x402) call receives it in the 402 quote before anything is charged; a call paid from prepaid credits is charged when the API accepts the request and answers `200`.
## Notes
* Without a modifier, the rows with no modifier are returned; with one, only that modifier's rows (for example 26 for the professional component and TC for the technical component).
* From 2026 each code has one rate per conversion factor: one for qualifying alternative payment model participants and one for all other clinicians, in that order. Earlier years have one rate.
* A practice expense the source marks not applicable gives null practice expense, total and payment for that setting, never zero.
* When the Medicare Administrative Contractor sets the amount (status C, or L for a local code), both national payments are null. The relative value units are returned as the source lists them.
* The source is the US Centers for Medicare & Medicaid Services indicators table of the physician payment schedule for the year; locality adjustments are not applied.
* No match, including a code not on the schedule for the year, completes with rates: \[] and a null status.
* Results return inline. The finished job stays available at `/v1/requests/{request_id}`
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