The Medicare physician fee schedule is updated each year. Anyone who treats a Medicare patient should be familiar with the current physician fee schedule, whether the doctor is classified as participating or non-participating. Not appropriately abiding by the fee schedule can result in significant legal problems.
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News
June 25, 2010
On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. CMS expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual
Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor. Review Frequently Asked Questions on the fee schedule here.
Accessing Your Fee Schedule
If you would like to access your fee schedule, it is advisable to contact your Medicare carrier/contractor directly. Because the fee schedule formula includes many different factors, including a geographic consideration, the most accurate information on fee schedule prices in your area will come from your individual Medicare carrier/contractor. If you are uncertain as to whether or not your carrier’s website is up to date, you may wish to call them directly.
You can also check out our Resources and Q&A sections for more information.
Resources
To access the most accurate information for your region, we recommend consulting with your local Medicare carrier. Your contractor/carrier website will likely have an educational section on the physician fee schedule, as well as information on how to order a print version of it.
Some Examples:
Links:
• CMS Fee Schedule Page (General)
• CMS Medicare Physician Fee Schedule Look-Up
• You can also visit this CMS webpage but be advised that the physician fee schedule may only be available from this site in a .zip file format.
For more information on the fee schedule, including a detailed explanation of participating versus non-participating billing, please visit our Q&As.
Historical Fee Schedule Info:
• 2009
• 2008
• 2007
• 2004
• 2002
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