Fee Schedules

The questions and answers below apply to the recent decision by the CMS to hold claims paid under the Medicare physician fee schedule up to 10 business days that contain July 2008 dates of service. [JSM 08389, PERL 200807-04]

To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims. [JSM 08382, PERL 200806-24]

This article describes changes to, and billing instructions for, payment policies implemented in the July 2008 Ambulatory Surgical Center (ASC) update. [MM6095]

Revisions to the Medicare physician fee schedule as a result of the July 2008 update. [CR 6087]

To access a file containing the quarterly additions and deletions to the list of ZIP Codes requiring a plus four extension refer to this link to the CMS Web site. [CR 5970]

Payment for services paid under the Medicare Physician Fee Schedule is determined by the ZIP code where the services are rendered. Certain ZIP codes fall into more than one payment locality and require a plus four ZIP code extension. [MM5970]

Carriers are required to update the rates for portable X-ray transportation allowances on an annual basis using independently determined measures of the cost of providing this service.

Beginning January 1, 2008, Metropolitan Statistical Areas (MSAs) are replaced by Core-Based Statistical Area (CBSAs). ASC providers need to know their CBSA before they can determine the correct fees.

Definitions of indicators used for each procedure code (and modifier, where applicable) on the Medicare physician fee schedule database (MPFSDB). Use this in conjunction with the MPFS - National Searchable Database on the CMS Web site. [CR 5774]

Conversion factors for use in calculating payment for anesthesia services for calendar year 2008. [CR 5944]

The information that follows provides definitions of the national policy indicators for each procedure code (and modifier, where applicable) on the 2007 Medicare physician fee schedule database (MPFSDB). [CR 5206]

Providers will have to determine payment amounts by comparing the MPFS/carrier-priced amounts to the cap amounts for the TC and global portion of imaging services. The lower amount will be paid. [CR 5448 and CR 5357]

[CMS Pub. 100-04/1102, CR 5358]

The following fee schedules are effective for mammography services furnished on or after January 1, 2007. [CR 5448]

[CR 5417]

This instruction supercedes the information published in the 2007 Medicare Part B Physician and Nonphysician Practitioner Fee Schedule[CR 5448]