Downcoding calculator
How much is downcoding costing your practice?
Enter a few rough numbers about your practice. No upload, no patient data — just an estimate of the revenue Medicare Advantage payers claw back by paying your E/M visits at a lower level than you billed.
Estimated annual revenue lost to MA downcoding
−$22,114
- Downcoded MA visits / month
- 48
- Recoverable at the ~80% appeal win rate
- $17,691 / yr
This is an estimate, not a finding. It assumes an average $38 recoverable per downcoded E/M visit (the national Medicare allowable gap between a 99214 and a 99213) and the downcode rate you entered. The downcode rate and MA share are assumptions you control, not claims about any specific payer. Your real figure comes from running your own 835 remittances through Receipts.
The Downcoding Index
Quarterly, de-identified rankings of which MA payers downcode the most. No spam, unsubscribe anytime.
See which payers downcode most →