Finding Medicare fee schedule – HOw to Guide

Fee schedule lookup tool – help guide

The fee schedule lookup tool was designed to provide users a more simplified approach to obtaining appropriate fee and policy information for most Medicare-covered procedure codes.

How to use the fee schedule lookup tool

The fee schedule lookup tool includes 4 to 5 main components (all of which are required):

1. Select Fee Schedule — select the appropriate fee schedule from the drop-down menu.

• Part A Options include:
• Ambulance
• ASP Drugs
• Clinical Lab
• Mammography
• Outpatient Rehabilitation

• Part B Options include:
• Ambulance
• Anesthesia
• ASC Drugs
• ASP Drugs
• Clinical Lab
• Medicare Physician and Nonphysician Practitioner Fee Scheduled (MPFS)

Note: You must change your line of business to view the alternative listing. To locate your current line of business, look under the First Coast logo, in the left navigation column. To change, simply click on the Part A or Part B link shown, and you will be prompted to select your settings

2. Date of Service — enter the date of service in the format of MM/DD/YYYY or click the calendar icon to select your date.

3. Location – Locality — select the location of service from the drop-down menu. Not sure of your locality? Click here to download CMS’ Zip Code to Carrier Locality file. compressed file
• Options for Florida include:
• Florida-03
• Florida-04
• Florida-99
• Options for Puerto Rico include:
• Puerto Rico-20
• Options for U.S. Virgin Islands include:
• U.S. Virgin Islands-50

4. County/Municipality (required for ASC and ASC Drugs) – select the county/municipality for the location of service

5. Procedure Code – enter the procedure code tfor the service provided (for example: 66984) and click the “Submit” button.

Results and links to additional information

Upon completing the short form and clicking the “Submit” button, the appropriate fee schedule data will be displayed based upon the information inputted.
Note: If you change information on the fee schedule lookup tool, such as “Date of Service”, you must click the “Submit” button again to update the results.

Example of the results for ASC – procedure code 66984:

Results — The results will vary upon the information inputted. The results for ASC– 66984 provide the following information:

• Procedure Code
• Modifier
• Effective Date
• Proc Ind
• Amount
• FC Mod Amount
• FB Mod Amount
• Penalty Amount
• FC Penalty Amount
• FB Penalty Amount
• LCDs