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Read the G0323 projection

Use the 2026 CMS carrier-file scenario without treating gross allowed amounts as collected revenue.

5 min readUpdated July 2026

What the example uses

The public example uses an unweighted $59.33 average across the reviewed 2026 CMS nonfacility G0323 carrier-file rows. Twenty payable care months equal $1,186.60 in illustrative gross allowed amount.

What the range shows

The reviewed nonfacility rows range from $53.56 to $74.37. The applicable amount depends on the locality and date of service.

What the projection does not include

  • It is not a coverage decision or payment promise.
  • It is not net cash collection.
  • It does not resolve qualifying-participant status, Medicare participation, the Medicare share, cost sharing, sequestration, secondary processing, denials, adjustments, or recoupments.
  • It does not establish that a provider or service has passed the route.
Keep in mind

Confirm the current CMS files, provider enrollment, client coverage, service record, and actual adjudication before using the amount for planning.

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