What fee schedules does Cloud Health Office support?

Cloud Health Office supports three CMS fee schedules: Medicare RBRVS (Physician Fee Schedule) for professional claims, Medicare OPPS (Outpatient Prospective Payment System) for facility outpatient claims, and Medicare MS-DRG for inpatient hospital claims. Custom and commercial fee schedules are available on paid tiers.

Is the claims repricing tool really free?

Yes. The free tier includes 1,000 claims per month across all three Medicare fee schedules with full RVU breakdown, modifier adjustments, and facility/non-facility rate differentiation. No credit card is required to get started.

How does Medicare RBRVS repricing work?

RBRVS (Resource-Based Relative Value Scale) pricing calculates the allowed amount using three RVU components: Work RVU, Practice Expense RVU, and Malpractice RVU. These are adjusted by Geographic Practice Cost Indices (GPCI) for the provider's locality, then multiplied by the CMS Conversion Factor to produce the final allowed amount.

Medicare Claims Repricing

Look up allowed amounts across CMS physician, outpatient, and inpatient fee schedules. Verify what Medicare pays for any procedure — instantly.

Try It Free View API Docs

What Is Claims Repricing?

Claims repricing determines what a health plan should pay for a medical service based on a contracted or reference fee schedule — rather than the provider's billed charges. It's the foundation of accurate claims adjudication, network adequacy analysis, and provider contract negotiation.

Cloud Health Office gives you direct access to the same CMS fee schedule data used by Medicare Administrative Contractors, so you can verify rates before paying a claim, audit existing payments, or benchmark your commercial contracts against Medicare.

Supported Fee Schedules

All three major CMS payment methodologies, updated for 2025.

RBRVS

Physician Fee Schedule

Work, PE & MP RVU components
Geographic (GPCI) adjustment
Facility / non-facility rates
Conversion factor applied
Modifier adjustments (50, 52, 62, 80)

OPPS

Outpatient Prospective Payment

APC assignment & payment rate
Status indicator logic
Device-intensive add-ons
Composite APC grouping
Multiple procedure discounting

MS-DRG

Inpatient Prospective Payment

DRG relative weight
Hospital base rate
Wage index adjustment
Outlier threshold
Transfer policy logic

Try It — Look Up a Rate

Enter a CPT or HCPCS code to see the Medicare allowed amount. No signup needed.

Procedure Code

Fee Schedule

Setting

Locality

Allowed Amount
—

Code—

Description—

Work RVU—

PE RVU—

MP RVU—

Conversion Factor—

Setting—

Fee Schedule—

Who Uses Claims Repricing?

Health Plans & TPAs

Price claims against Medicare or custom fee schedules during adjudication. Validate provider contracts and detect overpayments before they happen.

Revenue Cycle Teams

Verify expected reimbursement before submitting claims. Compare commercial rates against Medicare benchmarks to identify underpayments.

Actuaries & Analysts

Model network costs, build rate comparison reports, and benchmark fee schedules across geographies using CMS-sourced data.

Built on CMS Data You Can Trust

80K+

CPT/HCPCS Codes

Fee Schedules

1,000

Free Claims / Month

Credit Card Required

How It Works

1. Submit a Code

Enter a CPT, HCPCS, or DRG code with the fee schedule and place of service. Use the form above or call the REST API directly.

2. Get the Rate

Receive the Medicare allowed amount with full breakdown: RVU components, conversion factor, facility differential, and modifier adjustments.

3. Scale Up

Integrate via API for batch repricing. Connect to your claims adjudication pipeline or build custom rate comparison dashboards.

What's Included Free

✓ 1,000 claims per month
✓ All three Medicare fee schedules (RBRVS, OPPS, MS-DRG)
✓ Full RVU breakdown & modifier adjustments
✓ Facility / non-facility rate differentiation
✓ Multiple procedure payment reduction (MPPR)
✓ REST API with JSON responses
✓ No credit card, no contract, no vendor lock-in

Start Repricing Claims for Free

Get your API key in 30 seconds. Use the free tier as long as you want — upgrade only when your volume grows.

Get Free API Key See Full Platform Pricing