How do you read a Medicare fee schedule?


Quick Answer

Read a Medicare fee schedule by first accessing the version appropriate for the type of service, notes Noridian Healthcare Solutions. Separate fee schedules are available for physicians, clinical laboratories, ambulance, ambulatory surgery centers and radiopharmaceuticals. Each fee schedule is a comprehensive listing of fee maximums that Medicare pays physicians, other health care providers or suppliers as reimbursement on a fee-for-service basis.

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Full Answer

The current year's Medicare Part B Physician Fee Schedule is available for download through Medicare Administrative Contractors or by using the online lookup tool provided by the Centers for Medicare & Medicaid Services, notes Noridian Healthcare Solutions. The physician fee schedule contains the associated relative value units, status indicator and various payment policy indicators for payment adjustment for more than 10,000 physician services and their associated HCPCS codes, reports CMS.

Reading the Medicare Physician Fee Schedule requires a key to the file's column headings, explains Wisconsin Physicians Service. Columns indicate various limiting charges, modifiers, and the amount of reimbursement for participating and non-participating providers, Accurate reading of the fee schedule also requires knowing the appropriate geographic practice cost index for the location where the service is provided, since this index is applied in the calculation of fee schedule payment amounts, according to CMS.

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