The Medicare Physician Payment Schedule

The Medicare payment schedule’s impact on a physician’s Medicare payments is primarily a function of three key factors:

The resource-based relative value scale (RBRVS)
The geographic practice cost indexes (GPCIs)

The monetary conversion factor

The enabling legislation and regulations, as well as Medicare carrier correspondence and forms, refer to the Medicare physician payment schedule as a “fee schedule.” From the AMA’s perspective, the distinction between a payment schedule and a fee schedule is extremely important: a fee is what physicians establish as the fair price for the services they provide; a payment is what Medicare approves as the reimbursement level for the service. All references to the “full Medicare payment schedule” include the 80 percent that Medicare pays and the 20 percent patient coinsurance. Likewise, transition “approved amounts” also include the patient coinsurance.