Q. I’ve been using the “First Coast Service Options fee schedule look-up” for Part B — what do par fee, nonpar fee, and limiting charge mean?
A. Amounts listed under “par fee” represent the potential Medicare allowance for a physician or nonphysician practitioner who has signed a Medicare participation agreement (form CMS-460). (Click here for more information about the CMS-460.) Signing this agreement means the provider has agreed to accept Medicare allowances as payment in full; the benefits are therefore assigned to the provider.
Amounts listed under “nonpar fee” represent the potential Medicare allowance for a physician or nonphysician practitioner who has NOT signed a participation agreement; these allowances are generally 95 percent of the amount for a participating provider in the same area. Nonparticipating providers may choose to accept Medicare assignment or not.
The limiting charge is the maximum amount a nonparticipating provider may legally charge a beneficiary when filing an unassigned claim. The limiting charge for a service is 115 percent of the nonpar amount.
Q. Where can I obtain fee schedule policy indicators? For example, how can I find the global surgery days for a service? What about relative value units (RVUs) for a particular code?
A. Policy indicators for procedure codes in the Medicare physician fee schedule database (MPFSDB) are available in First Coast Service Options’ fee lookup tool. Select Medicare Physician and Nonphysician Practitioner Fee Schedule (MPFS) from the drop-down list enter a date of service, location, and procedure code, and select submit. Then select the “more” links in the modifier field to view MPFS policy indicators.
These Indicators include: global surgery including pre-operative, intra-operative, and post-operative days, PCTC (professional/technical component), multiple surgery, bilateral surgery, assistant surgery, cosurgery, team surgery, physician supervision requirements, and base codes for multiple endoscopy procedures. For more information regarding these indicators, click here.
Also included are work, practice expense and malpractice expense geographic practice cost indices (GPCIs) and relative value units (RVUs). Note: the allowances Medicare contractors use in their claims payment system use these factors, in combination with an annual conversion factor, but allowances are not calculated at the local level. The allowances are furnished to contractors by CMS after all calculations have been completed.
Q. In the fee schedule lookup tool — what do the question marks in the column headers mean?
A. These are Tooltips. When the cursor is placed over the “?” on any of these items, helpful tooltips will appear, providing a description for each category.