General Fee Information

Key to Reading Column Headings on the Physician Fee Schedule

Limiting Charge
Maximum amount the beneficiary may be billed (applies to services on unassigned claims submitted by Non-participating Providers)
Mod
Modifier
Non-Par Amount
Fee Schedule Amount for Non-Participating Providers
Par Amount
Fee Schedule Amount for Participating Providers

CMS Resources

Medicare Physician Fee Schedule Database (MPFSDB)/Fee Schedule Look-Up
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.). Note: The assistant at surgery payment policy indicators for HCPCS/CPT codes can be found on the Medicare Physician Fee Schedule Database.

The Centers for Medicare & Medicaid Services (CMS) provides fee and reimbursement information to Medicare Contractors. CMS updates these amounts on a quarterly basis or as otherwise required and issues a Change Request (CR) to alert the contractors and the provider community of any changes. WPS Medicare then publishes the notification in our Listserv messages and posts the updated fee information to our Fee and Reimbursement pages.

The CMS CR provides instructions on both the effective date and implementation date of the change. These dates may not always be the same. Please watch the effective dates on the fees carefully to determine what dates the updated fees apply to.

The CMS instructions do not require Medicare contractors (WPS Medicare) to retrieve history to determine if an overpayment or underpayment exists. We will only adjust claims brought to our attention. Providers must make the request for any additional payment or recovery through our redetermination process. You can find the forms and instructions on our website.

Page Last Updated: Tuesday, 10-Jan-2012 08:37:31 CST