Tuesday, July 6, 2010

Place of Service Crosswalk

 Place of Service Crosswalk  
 Type of Bill    Type of Bill Position 1 (Type of Facility)    Type of Bill Position 2 (Bill Classification)    Place of Service*    Place of Service Description 
 11X    Hospital    Inpatient    21    Inpatient Hospital  
 12X    Hospital    Inpatient    21    Inpatient Hospital  
 13X    Hospital    Outpatient    22    Outpatient Hospital  
 14X    Hospital    Other    22    Outpatient Hospital  
 18X    Hospital    Swing Bed    21    Inpatient Hospital  
 21X    Skilled Nursing    Inpatient    31    Skilled Nursing Facility  
 22X    Skilled Nursing    Inpatient    31    Skilled Nursing Facility  
 23X    Skilled Nursing    Outpatient    32    Nursing Facility  
 28X    Skilled Nursing    Swing Bed    32    Nursing Facility  
 32X    Home Health    Inpatient    12    Home  
 33X    Home Health    Outpatient    12    Home  
 34X    Home Health    Other    12    Home  
 41X    Religious Nonmedical    Inpatient    21    Inpatient Hospital  
 42X    Religious Nonmedical    Inpatient    21    Inpatient Hospital  
 43X    Religious Nonmedical    Outpatient    22    Outpatient Hospital  
 65X    Intermediate Care    Intermediate Care—Level I    54    Intermediate Care Facility/Mentally Retarded  
 66X    Intermediate Care    Intermediate Care—Level II    54    Intermediate Care Facility/Mentally Retarded  
 71X    Clinic or Hospital Based Renal Dialysis Facility    Rural Health Clinic (RHC)    72    Rural Health Clinic  
 72X    Clinic or Hospital Based Renal Dialysis Facility    Hospital Based or Independent Renal Dialysis Facility    65    End-Stage Renal Disease Treatment Facility  
 73X    Clinic or Hospital Based Renal Dialysis Facility    Free Standing Provider-Based Federally Qualified Health Center (FQHC)    49    Independent Clinic  
 74X    Clinic or Hospital Based Renal Dialysis Facility    Outpatient Rehabilitation Facility (ORF)    49    Independent Clinic  
 75X    Clinic or Hospital Based Renal Dialysis Facility    Comprehensive Outpatient Rehabilitation Facility (CORF)    62    Comprehensive Outpatient Rehabilitation Facility  
 76X    Clinic or Hospital Based Renal Dialysis Facility    Community Mental Health Center (CMHC)    53    Community Mental Health Center  
 79X    Clinic or Hospital Based Renal Dialysis Facility    OTHER    49    Independent Clinic  
 81X    Special facility or hospital ASC surgery    Hospice (Nonhospital Based)    34    Hospice  
 82X    Special facility or hospital ASC surgery    Hospice (Hospital Based)    34    Hospice  
 83X    Special facility or hospital ASC surgery    Ambulatory Surgical Center Services to Hospital Outpatients    24    Ambulatory Surgical Center 
 84X    Special facility or hospital ASC surgery    Free Standing Birthing Center    25    Birthing Center  
 85X    Special facility or hospital ASC surgery    Critical Access Hospital    22    Outpatient Hospital  
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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