Thursday, July 29, 2010

Medicare Modifiers




-A1 Dressing for one wound
-A2 Dressing for two wounds
-A3 Dressing for three wounds
-A4 Dressing for four wounds
-A5 Dressing for five wounds
-A6 Dressing for six wounds
-A7 Dressing for seven wounds
-A8 Dressing for eight wounds
-A9 Dressing for nine or more wounds
-GA Waiver of liability statement (ABN) on file with ABN waiver signed
-GY item or service statutorily excluded, does not meet the definition of any Medicare benefit
or for non-Medicare insurance, is not a contract benefit No need to get ABN waiver
-GZ item or service expected to be denied as not reasonable and necessary
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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