Tuesday, June 1, 2010

Global payment, professional and technical payment

Fee. The payment value for the medical procedure or item contained in 114.3 CMR 40.06 and identified by a Code. Fees may be listed as Professional Component Fee ("PC Fee"), Technical Component Fee (“TC Fee”) and Global Fee ("GL Fee") when a professional, technical or global fee applies. Single payment rates are listed as "Fees". See definitions of (GL), (PC) and (TC) below.

Global payment (GL). The Global Fee is the sum of the PC Fee and TC Fee. See definitions of (PC) and (TC) below

Professional Component payment (PC). Certain procedures are a combination of a physician, or professional component and a technical component. When the modifier –26 is added to an appropriate code a PC allowable amount shall be paid..

Technical Component payment (TC). The TC component reflects the technical portion of the radiology, laboratory, medical, or surgical procedure code. When the technical component is provided by a health care provider other than the physician providing the professional component, the health care provider bills for the technical component by adding Modifier –TC to the applicable code. The TC rate is payment for the facility’s cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and all other overhead expenses.
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download