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IMPORTANT CHANGE FOR 2007:
Section 5102(b) of the Deficit Reduction Act of 2005 requires a payment
cap on the technical component (TC) of certain diagnostic imaging procedures
and the TC portions of the global diagnostic imaging services. This cap is
based on the Outpatient Prospective Payment System (OPPS) payment. To
implement this provision, the user must compare the physician fee schedule
amount with the OPPS payment amount. The lower amount is used for payment
under the Medicare Physician Fee Schedule.
This website is designed
to provide information on services covered by the Medicare Physician Fee
Schedule (MPFS). It provides more than 10,000 physician services,
the associated relative value units, a fee schedule status indicator, and
various payment policy indicators needed for payment adjustment (i.e., payment
of assistant at surgery, team surgery, bilateral surgery, etc.).
The Medicare physician
fee schedule pricing amounts are adjusted to reflect the variation in
practice costs from area to area. A geographic practice cost index (GPCI)
has been established for every Medicare payment locality for each of the
three components of a procedure's relative value unit (i.e., the RVUs
for work, practice expense, and malpractice). The GPCIs are applied in
the calculation of a fee schedule payment amount by multiplying the RVU
for each component times the GPCI for that component.
This site is designed
to take you through the selection steps prior to the display of the information.
The site allows you to:
- search pricing
amounts, various payment policy indicators, RVUs, and GPCIs by a single
procedure code, a range and a list of procedure codes.
- search for the
nation, a specific carrier, or a specific carrier locality. Each page
has associated Help/Hint available to complete your selections.
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