MEDICARE PHYSICIAN FEE SCHEDULE
ICN 006814 February 2017
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
● Ambulatory Surgical Centers
● Skilled Nursing Facilities and other post-acute care settings
● 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.
You can use the Physician Fee Schedule Search Tool to obtain national and local payment rates.
For information on how to use the Physician Fee Schedule Search Tool, refer to How to Use the Searchable Medicare Physician Fee Schedule
Method for Computing Fee Schedule Amount
The applicable national conversion factor (CF) is then used in the computation of every MPFS amount.
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)
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