Q:

What information is listed in the Medicare fee schedule?

A:

Quick Answer

The Medicare fee schedule lists the maximum fees for which Medicare reimburses physicians and other medical care providers for each of their services, states the Centers for Medicare & Medicaid Services. CMS provides fee schedules for physician services, ambulance services, clinical laboratory services and qualifying supplies. Physician services include office visits, surgical procedures and anesthesia, reports Noridian Healthcare Solutions. Each ZIP code has a separate fee schedule to reflect differences in costs for various locations.

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Full Answer

CMS determines fees based on a Resource-Based Relative Value Scale that measures a provider's work, a practice's expenses and malpractice insurance costs, explains the American College of Radiology. The agency calculates the relative value units of each component to establish the fee maximum and adjusts for regional differences in costs using a geographic practice cost index. It lists these fees by CPT code on the fee schedule.

Medicare fee schedules list different maximums for a service in a hospital setting versus one in an office or clinic setting, according to the American College of Radiology. Healthcare providers performing a service in a non-hospital setting must provide clinical staff, supplies and equipment, so they qualify for higher maximums. CMS also adjusts their fees by a conversion factor that ensures budget neutrality, per the Omnibus Budget Reconciliation Act and the Balanced Budget Act.

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