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In the Physician Fee Schedule, the # symbol is used to indicate amounts that apply when the service is performed in a facility setting. The following place of service codes identify facilities:
| 21 |
Inpatient Hospital |
41 |
Ambulance - Land |
| 22 |
Outpatient Hospital |
42 |
Ambulance - Air or Water |
| 23 |
Emergency Room - Hospital |
51 |
Inpatient Psychiatric Facility |
| 24 |
Ambulatory Surgical Center* |
52 |
Psychiatric Facility - Partial Hospitalization |
| 26 |
Military Treatment Facility |
53 |
Community Mental Health Center |
| 31 |
Skilled Nursing Facility |
56 |
Psychiatric Residential Treatment Facility |
| 34 |
Hospice |
61 |
Comprehensive Inpatient Rehabilitation Facility |
* Ambulatory Surgical Center (ASC) is only treated as a facility setting when an ASC list procedure is performed in an ASC. |
2008 Physician Fee Schedule - Revised 7-16-08
New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008, through December 31, 2008
Posted July 16, 2008
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with the January - June 2008 0.5 percent update, retroactive to July 1, 2008.
Physicians, non-physician practitioners, and other providers of services paid under the MPFS should begin to receive payment at the 0.5 percent update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.
In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6 percent update level. After your local contractor begins to pay claims at the new 0.5 percent rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.
Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 - June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.
Contractor Web sites are being updated with the new rates and these should be available shortly.
Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate.
Finally, be on the alert for more information about other legislative provisions which may affect you.
| Fee Updates - Click here for updates to the 2008 Physician Fee Schedule. |
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Ordering Fee Schedule Hard Copies
To request a hard copy of the 2008 Medicare Physician Fee Schedule, you can write to the following address. Please note that there is no longer a charge for fee schedule hard copies.
General Correspondence
Upstate Medicare Division
P.O. Box 5302
Binghamton, NY 13902-5302
2007 Physician Fee Schedule - Revised 7-13-07
| Fee Updates - Click here for updates to the 2007 Physician Fee Schedule. |
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Section 5102(b) of the Deficit Reduction Act of 2005 requires a payment cap on the technical component (TC) of diagnostic imaging procedures. For the TC of diagnostic imaging services, including the TC portions of the global imaging services, the payment will be capped based on the Outpatient Prospective Payment System (OPPS).
Previously, imaging services on the Medicare Physician Fee Schedule Database (MPFSDB) that are deemed subject to this cap were required to have the cap amount disclosed in addition to the MPFSDB payment amount.
In July 2007, the MPFSDB disclosure report format was revised to display a denotation mark (denotation "C" in the "Note" field) for diagnostic imaging procedures for which payment is capped at the OPPS payment amount. There is no longer a separate listing of the cap amounts.
The limitation of the physician fee schedule amount to the level of the OPPS payment amount applies to the TC portion when the global service is billed, and when the TC portion is billed alone. To determine if OPPS payment applies to the TC of diagnostic imaging services, the physician fee schedule amount was compared to the OPPS amount. If the lowest amount is the OPPS amount, the disclosure report is marked as being capped at the OPPS payment amount.
Ordering Fee Schedule Hard Copies
To request a hard copy of the 2007 Medicare Physician Fee Schedule, you can write to the following address. Please note that there is no longer a charge for fee schedule hard copies.
General Correspondence
Upstate Medicare Division
P.O. Box 5302
Binghamton, NY 13902-5302
2006 Physician Fee Schedule - Effective January 1, 2006 - Revised 2-16-06
| Fee Updates - Click here for updates to the 2006 Physician Fee Schedule. |
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The Physician Fee Schedule is presented here broken down by code ranges. Click the desired code range link to access the fees for that range.
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