Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,

Medicare payment fee schedule  is changing from state to state and county to county. Hence before download any fee schedule implementation, please make sure that you are choosing the correct county and state.

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.  This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.  CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies.  See Related Links below for information about each specific fee schedule.

2010 Medicare Part B Fee Schedule for Delaware (DE),  District of Columbia Metropolitan Area (DCMA), Maryland (MD), New Jersey  (NJ), and Pennsylvania (PA) has been posted in https://www.highmarkmedicareservices.com/partb/index-feeinfo.html

2010 Medicare Part B Fee Schedule  for Connecticut, Indiana, Kentucky and New York has been posted in http://www.empiremedicare.com/
(please select Part B and specify the  region, you will be directed to 2010 Fee Schedule Database)

2010 Medicare physician fee schedule (MPFS)  updates for Florida, Puerto Rico and U.S. Virgin Islands are posted in http://medicare.fcso.com/Fee_news/

2010 Part B Medicare Physician Fee Schedule for  California (Jurisdiction 1 [J1] Part B) has been posted @ http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction%201%20Part%20B~Publications~Fee%20Schedules~Medicare%20Physician%20Fee%20Schedules%20and%20Updates~8525746A00550AA38525768100694D43

2010 Part B Medicare and Clinical Lab Fee Schedules for  the states Maine (ME), Massachusetts (MA), New Hampshire (NH), Vermont  (VT) and Rhode Island (RI) are posted @ http://www.medicarenhic.com/ne_prov/fee_sched.shtml

To view 2010  Medicare Fee Schedule for all regions please refer 
http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=2&sortOrder=descending&itemID=CMS1231104&intNumPerPage=10 (The Centers for Medicare  & Medicaid Services (CMS) has condensed all 56 Physician Fee  Schedule (PFS) carrier specific pricing files into one zip file) 

The final rule for payment policies under the Physician Fee Schedule  and other Revisions to Part B for CY 2010 has been posted in
http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf

Zip code look up to specific  Carrier Locality http://www.cms.hhs.gov/FeeScheduleGenInfo/
2010 Durable Medical Equipment Prosthetics,  Orthotics and Supplies (DMEPOS) Fee Schedule for all States has been  posted @ http://www.cms.hhs.gov/DMEPOSFeeSched/LSDMEPOSFEE/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS1231049&intNumPerPage=10


Method for Computing Fee Schedule Amount

The CMS continually updates, refines, and alters the methods used in computing the fee schedule amount. For example, input from the American Academy of Ophthalmology has led to alterations in the supplies and equipment used in the computation of the fee schedule for selected procedures. Likewise, new research has changed the payments made for physical and occupational therapy. The CMS provides the updated fee schedules to carriers on an annual basis. The sections below introduce the formulas used for fee schedule computations.

A. Formula

The fully implemented resource-based MPFS amount for a given service can be computed by using the formula below:

MPFS Amount = [(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] x CF

Where:

RVUw equals a relative value for physician work,
RVUpe equals a relative value for practice expense, and
RVUm refers to a relative value for malpractice.

In order to consider geographic differences in each payment locality, three geographic
practice cost indices (GPCIs) are included in the core formula:
A GPCI for physician work (GPCIw),
A GPCI for practice expense (GPCIpe), and
A GPCI for malpractice (GPCIm).
The above variables capture the efforts and productivity of the physician, his/her
individualized costs for staff and for productivity-enhancing technology and materials.
The applicable national conversion factor (CF) is then used in the computation of every
MPFS amount.

The national conversion factors are:
2002 - $36.1992
2001 - $38.2581
2000 - $36.6137
1999 - $34.7315
1998 - $36.6873
1997 - $40.9603 (Surgical); $33.8454 (Nonsurgical); $35.7671 (Primary Care)
1996 - $40.7986 (Surgical); $34.6296 (Nonsurgical); $35.4173 (Primary Care)
1995 - $39.447 (Surgical); $34.616 (Nonsurgical); $36.382 (Primary Care)
1994 - $35.158 (Surgical); $32.905 (Nonsurgical); $33.718 (Primary Care)
1993 - $31.926 (Surgical); $31,249 (Nonsurgical);
1992 - $31.001

For the years 1999 through 2002, payments attributable to practice expenses transitioned from charge-based amounts to resource-based practice expense RVUs. The CMS used the following transition formula to calculate the practice expense RVUs.
1999 - 75 percent of charged-based RVUs and 25 percent of the resource-based RVUs.
2000 - 50 percent of the charge-based RVUs and 50 percent of the resource-based RVUs.
2001 - 25 percent of the charge-based RVUs and 75 percent of the resource-based RVUs.
2002 - 100 percent of the resource-based RVUs.

As the tabular display introduced earlier indicates, CMS has calculated separate facility
and nonfacility resource-based practice expense RVUs.


 

Top Medicare billing tips