HOW DO I FIND MY MEDICARE FEE SCHEDULE?

The Medicare fee schedule is a list of all the payments that Medicare pays to doctors and other healthcare providers/suppliers. On a fee-for-service basis, this comprehensive listing of fee maximums is utilized to reimburse a physician and/or other providers. Medicare typically covers 80% of the cost of covered services that are mentioned in the fee schedules. The article explains how healthcare providers can find their Medicare fee schedule and other relevant information.

Centers for Medicare & Medicaid Services (CMS)

CMS is responsible for developing fee schedules for physicians, ambulance services, clinical laboratory services, durable medical equipment, prosthetics, orthotics, and supplies. You can find all the relevant information at the official website of CMS.

The Physician Fee Schedule look-up website is set up to guide you through the selection process before displaying the results. You can do the following on the website:

• You can search for a single process code to get a range or a list of procedure codes, prices, various payment policy indicators, Relative Value Units (RVUs), and Geographic Practice Cost Index (GPCIs).
• Look up the nationwide payment amount, a specific Medicare Administrative Contractor (MAC), or a specific MAC area. To help you complete your selections, each page offers a Help/Hint button.

How is it calculated?

The Medicare Physician Fee Schedule (MPFS) employs a resource-based relative value system (RBRVS), which assigns a relative value to CPT codes developed and copyrighted by the American Medical Association (AMA) with input from representatives of healthcare professional associations and societies, including ASHA (American Society for Health for All). The resource-based relative value scale determines the relative weighting factor (relative value unit or RVU).

The components of the RBRVS for each procedure are:

(a) Professional component or Physician work (i.e., work as expressed in the amount of time, technical skill, physical effort, stress, and judgment required of physicians and certain other medical practitioners for the procedure). It accounts for an average of 51 percent of the total relative value for each service.

(b) Technical component or practice expense (i.e., practice expense expressed in overhead costs such as assistant’s time, equipment, and supplies). It accounts for an average of 45 percent of the total relative value for each service.

(c) Professional liability component or malpractice expense (i.e., professional component as expressed in the amount of time, technical skill, physical effort, stress, and judgment. It usually accounts for an average of 4 percent of the total relative value for each service.

Amendments in 2021 Schedule

The Consolidated Appropriations Act of 2021 made the following changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2021:

• MPFS payments will be increased by 3.75 percent in the fiscal year 2021.
• The 2% payment modification (sequestration) has been postponed until March 31, 2021.
• Through CY 2023, the 1.0 floor on the work Geographic Practice Cost Index has been reinstated.
• The inherent complexity add-on code for evaluation and management services (G2211) has been postponed until the calendar year 2024.

The MPFS payment rates and conversion factor have been revised by the CMS to reflect these changes. For the calendar year 2021, the updated MPFS conversion factor is 34.8931. All the information regarding this can be found on the above-mentioned website.

Medical Association (AMA) with input from representatives of healthcare professional associations and societies, including ASHA. A resource-based relative value scale determines the relative weighting factor (relative value unit or RVU).