Medicare: 2012 Physician Fee Schedule

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

December 23, 2011--Congress Passes Two Month Delay of Medicare Fee Cuts

The 2012 Physician Fee Schedule Final Rule that was put on display at the Office of the Federal Register on November 1, 2011, provided a negative update to the Medicare Sustainable Growth Rate (SGR) payment formula that would have cut reimbursement to Medicare providers, including doctors of chiropractic, by 27.4 percent. However, on December 23, 2011, the payroll tax extension legislation that was passed by Congress and signed by President Obama (Public Law 112-078) included a provision that delayed--for two months--the cut in reimbursement to Medicare. Therefore, for January 1, 2012 – February 29, 2012, physician payments have been updated by zero percent.

A conference committee has been convened to begin working on a longer-term sustainable growth rate (SGR) fix and payroll tax extension. ACA has developed an Issue Brief, entitled Repeal the Flawed and Unsustainable Medicare Physician Payment Model, that can be accessed here

Please be on the alert for more information about the 2012 physician update as it becomes available.

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.



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:

 

State or MAC & Medicare Carrier/Contractor Website Fee Schedule Info
 J12: Highmark Medicare Services click here
FL:  First Coast Service Options, Inc click here
J14:  National Heritage Insurance Company (NHIC) click here

 

Links:

• CMS Fee Schedule Page (General) 
CMS Medicare Fee Schedule Look Up
• You can also visit this CMS webpage to view Physician Fee Schedule Carrier Specific Files 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:
2011
2009
• 2008
• 2007
• 2004
• 2002