Medicare Physician Fee Schedule - Florida

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DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid ServicesOpen aText-Only VersionMedicare Physician Fee SchedulePAYMENT SYSTEM SERIESICN 006814 December 2016

Please note: The information in this publicationapplies only to the Medicare Fee-For-ServiceProgram (also known as Original Medicare).The Hyperlink Table, at the end of this document,provides the complete URL for each hyperlink.Learn about these Medicare Physician FeeSchedule (PFS) topics: Physician services Medicare PFS payment rates Quality Payment Program (QPP)Physicians’ services are furnished in all settings,including: Physicians’ offices Hospitals Ambulatory Surgical Centers Skilled Nursing Facilities and other post-acutecare settings Hospices Outpatient dialysis facilities Clinical laboratories Beneficiaries’ homes ResourcesMedicare PFS Payment RatesPhysician ServicesMedicare Part B pays for physician services basedon the Medicare PFS, which lists the more than7,000 unique codes and their payment rates.Physicians’ services include: Office visits Surgical procedures Anesthesia services A range of other diagnostic and therapeuticservices2Medicare Physician Fee ScheduleThe Medicare PFS payment rates formula showshow a payment rate for an individual service isdetermined, and we provide a description for eachcomponent below the formula.

Medicare PFS Payment Rates FormulaPaymentWork RVU xWork GPCIPE RVU xPE GPCI1) Relative Value Units (RVUs)Three separate RVUs are associated with calculatinga payment under the Medicare PFS: The Work RVU reflects the relative time andintensity associated with furnishing a MedicarePFS service The Practice Expense (PE) RVU reflects thecosts of maintaining a practice (such as rentingoffice space, buying supplies and equipment,and staff costs) The Malpractice (MP) RVU reflects the costsof malpractice insurance2) Geographic Practice Cost Indices (GPCIs)Each of the three RVUs are adjusted to accountfor geographic variations in the costs of practicingmedicine in different areas within the country. Theseadjustments are called GPCIs, and each kind of RVUcomponent has a corresponding GPCI adjustment.3) Conversion Factor (CF)To determine the payment rate for a particularservice, the sum of the geographically adjustedRVUs is multiplied by a CF in dollars. The statutespecifies the formula by which the CF is updated onan annual basis.You can use the Physician Fee Schedule SearchTool to obtain national and local payment rates.For information on how to use the Physician FeeSchedule Search Tool, refer to How to Use theSearchable Medicare Physician Fee Schedule.3Medicare Physician Fee ScheduleMP RVU xMP GPCICFQPPEffective January 1, 2017, the Medicare Accessand CHIP Reauthorization Act of 2015 repealed theprevious formula to update the Medicare PFS andreplaced it with several years of increases to overallpayments for PFS services. In conjunction with thatchange, the law created the QPP, which rewards thedelivery of high-quality and cost-efficient patient care.You may choose from these tracks: Advanced Alternative Payment Models to earnan incentive payment for participation. The Merit-based Incentive Payment Systemto earn a performance-based adjustment toyour Medicare payment. It consolidates thecomponents of the Physician Quality ReportingSystem, Physician Value-based PaymentModifier, and Medicare Electronic Health RecordIncentive Program for Eligible Professionals.

ResourcesThis table provides Medicare PFS resource information.Medicare PFS ResourcesFor More Information About Medicare cePayment/PhysicianFeeSchedChapter 12, Section 20 of the Medicare ClaimsProcessing Manual (Publication 100-04)Medicare PFS Proposed and Final s.htmlQPPQPP.cms.govAll Available Medicare Learning Network (MLN)ProductsMLN CatalogProvider-Specific Medicare InformationMLN Guided Pathways: Provider Specific MedicareResourcesMedicare Information for PatientsMedicare.govHyperlink TableEmbedded HyperlinkComplete URLPhysician Fee Schedule Search e/overview.aspxHow to Use the Searchable Medicare Physician loads/How to MPFS Booklet ICN901344.pdfChapter 12, Section 20 of the Medicare ClaimsProcessing Manual (Publication e/Guidance/Manuals/Downloads/clm104c12.pdfMLN s/MLNCatalog.pdfMLN Guided Pathways: Provider Specific ide/Downloads/Guided Pathways Provider Specificbooklet.pdf4Medicare Physician Fee Schedule

The Medicare Learning Network Disclaimers are available at http://go.cms.gov/Disclaimer-MLN-Product.The Medicare Learning Network , MLN Connects , and MLN Matters are registered trademarks of the U.S. Departmentof Health & Human Services (HHS).Check out CMS on:Twitter5LinkedIn YouTubeMedicare Physician Fee Schedule

You can use the Physician Fee Schedule Search . Tool to obtain national and local payment rates. For information on how to use the Physician Fee Schedule Search Tool, refer to How to Use the Searchable Medicare Physician Fee Schedule. QPP. Effective January 1, 2017, the Medicare A

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Medicare Physician Fee Schedule Author: CMS/CM/PCG/DPIPD Subject: Medicare Physician Fee Schedule Keywords: Medicare Physician Fee Schedule, PFS, payment rates, formula, relative value units, RVU, conversion factor, CF, geographic practice cost index, GPCI Created Date: 6/12/2014 3:45:35 PM

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