Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203

 Here is the Fee schedule or allowed amount from Medicare for the CPTs if it has been performed in office setup . POS 11. This amount will vary from state to state and this amount is for Florida state.


CPT CODE         2016 Fee   2017 FEE

99201 $35.96     $43.6
99202 $61.32     $74.5
99203 $89.52    $108.3
99204 $135.38  $165.7
99205 $169.54  $208.2
99211 $20.07    $19.63
99212 $37.17     $43.1
99213 $58.89     $72.7
99214 $88.33     $107.2
99215 $118.95    $144.8

90658 $13.22  
G0008 $18.57
90732 $29.73
G0009 $18.57
90703 $20.21
90471 $20.87
90472 $10.13
90746 $57.26
J3420 $0.55
J0780 $1.11
J1940 $0.25
94760 $2.64
94010 $34.75
81002 $3.57
81000 $4.43
86580 $8.66
82947 $5.48
82270 $4.54
86510 $9.46
93000 $23.11       $18
69210 $44.76       $51
46600 $77.55
36415 $3.00
90632 $53.45




Medicaid - Update of the Practitioner Fee Schedule Effective 7/1/2016


The Florida Legislature appropriated additional funding during the 2016 Legislative Session to the Agency for Health Care Administration (Agency), to provide a rate increase for certain critical neonatal intensive care and pediatric intensive care unit services covered under Florida Medicaid.

The Agency is increasing the reimbursement for the following critical care Current Procedural Terminology (CPT) codes for services provided through the fee-for-service delivery system.  This change is retroactively effective to July 1, 2016.

Updates to Practitioner Fee Schedule

Effective July 1, 2016

Procedure Mod FSI PCI TCI PA AS
99468 577.84
99469 243.46
99471 537.26
99472 250.83
99475 353.26
99476 212.22
99477 218.73
99478 83.76
99479 76.16
99480 73.13
 
The Agency will reprocess claims submitted directly to the Medicaid fiscal agent (fee-for-service claims) for dates of service beginning July 1, 2016 to make adjustments to the amount paid to providers to align reimbursement for these CPT codes with this change.  However, it may take several months for the reprocessing task to be completed.  Providers have the option of voiding and resubmitting previously paid claims in order to effectuate quicker reimbursement.


Providers should refer to their contract with each health plan to determine whether this change will impact their reimbursement from the plan for services provided to managed care enrollees


PHYSICIAN SERVICES

Medicare Part B pays for physician services based on the Medicare PFS, which lists the  more than 7,000 unique codes and their payment rates. Physicians’ services include:

* Office visits
* Surgical procedures
* Anesthesia services
* A range of other diagnostic and therapeutic services Physicians’ services are furnished in all settings, including:
* Physicians’ offices
* Hospitals
* Ambulatory Surgical Centers
* Skilled Nursing Facilities and other post-acute care settings
* Hospices
* Outpatient dialysis facilities
* Clinical laboratories
* Beneficiaries’ homes

MEDICARE PFS PAYMENT RATES

The Medicare PFS payment rates formula shows how a payment rate for an individual service is determined, and we provide a description for each component below the formula.

1) Relative Value Units (RVUs) Three separate RVUs are associated with calculating a payment under the Medicare PFS:

* The Work RVU reflects the relative time and intensity associated with furnishing a Medicare PFS service

* The Practice Expense (PE) RVU reflects the costs of maintaining a practice (such as renting office space, buying supplies and equipment, and staff costs)

* The Malpractice (MP) RVU reflects the costs of malpractice insurance

2) Geographic Practice Cost Indices (GPCIs) Each of the three RVUs are adjusted to account for geographic variations in the costs of practicing medicine in different areas within the country. These adjustments are called GPCIs, and each kind of RVU component has a corresponding GPCI adjustment.

3) Conversion Factor (CF)

To determine the payment rate for a particular service, the sum of the geographically adjusted RVUs is multiplied by a CF in dollars. The statute specifies the formula by which the CF is updated on an annual basis.

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