2012 Fee Schedules
2012 Medicare Physician Fee Schedules
Revised Zero Percent 2012 Medicare Physician Fee Schedules
(Effective for dates of service 01/01/2012 through 12/31/2012.)
Instructions for Downloading:
The fee schedules have been placed in two different file types. There is a PDF version for easy viewing/printing, while in the other column, the files have been placed in a .zip file. Within the zip file, the fees have been placed in an Excel and PDF format for use.
Congress recently passed the Middle Class Tax Relief and Job Creation Act of 2012. With some exceptions, this bill extends the current zero percent (0%) update for the MPFS through the end of 2012. The extension does NOT continue the 5% physician fee schedule Mental Health Add-on payment or the 2011 payment rates for bone mass measurement. The following 2012 MPFS payment rates are now effective through December 31, 2012. To view the revised Mental Health and Bone Density MPFS fee schedules that are effective March 1, 2012 through December 31, 2012, please click on the link found under the Updates to the 2012 Medicare Physician Fee Schedule heading below.
Note: A revision was made on 03/08/2012 to the Physician's Fee Schedules below to correct the Anesthesia Conversion Factors. The revised rates are effective for Dates of Service 01/01/2012 through 12/31/2012. The corrected conversion factors will appear on claims for all 2012 dates of service that are processed or reprocessed on or after 03/02/2012.
|State/Locality||Types of Files|
|Iowa (Revised 03/01/2012)||Download|
|Kansas (Revised 03/01/2012)||Download|
|Missouri Locality 01 (Revised 03/01/2012)||Download|
|Missouri Locality 02 (Revised 03/01/2012)||Download|
|Missouri Locality 99 (Revised 03/01/2012)||Download|
|Nebraska (Revised 03/01/2012)||Download|
Updates to the 2012 Medicare Physician Fee Schedule
- 2012 Medicare Physician Fee Schedule Carrier Priced Fees Established for Codes 0256T, 0257T, 0258T, & 0259T
- 2012 Medicare Physician Fee Schedule Carrier Priced Fees Established for Codes 0295T, 0296T, 0297T, & 0298T
- 2012 Medicare Physician Fee Schedule RVU and Fee Updates for Carrier Priced Codes 77520, 77522, 77523 & 77525
- 2012 MPFS amounts effective 03/01/2012 through 12/31/2012 for Mental Health and Bone Density services
- April Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB) (MM 7745)
- July Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB) (MM 7844)
- October Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB)
(Revised MM 8017)
For additional information on procedures, including 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.) you may wish to access the Medicare Physician Fee Schedule Database (MPFSDB)/ Relative Value File on the CMS website.
CMS offers the complete file in several different formats and also provides a single code look up.
Access the Medicare Physician Fee Schedule Database (MPFSDB)/Relative Value File on the CMS website.
2012 Specialty Pricing
(Effective for dates of service 01/01/2012 and after)
Chiropractic and Clinical Psychologist
The chiropractic and clinical psychologist fees are available in the Medicare Physician Fee Schedule.
Clinical Social Worker
The clinical social worker fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 75%.
For Clinical Lab Fee Schedules that are linked to below, the localities for KS and MO are defined as follows:
KS Lab locality 12 (Western Kansas) = Rest of State
KS Lab Locality 15 (Eastern Kansas) = Johnson and Wyandotte Counties
MO2 Lab Locality 07 (Eastern Missouri) = City of St. Louis plus counties of Adair, Audrain, Barry, Barton, Bollinger, Boone, Butler, Callaway, Camden, Cape Girardeau, Carter, Cedar, Chariton, Christian, Clark, Cole, Cooper, Crawford, Dade, Dallas, Dent, Douglas, Dunklin, Franklin, Gasconade, Greene, Hickory, Howard, Howell, Iron, Jasper, Jefferson, Knox, Laclede, Lawrence, Lewis, Lincoln, Linn, Macon, Madison, Maries, Marion, McDonald, Miller, Mississippi, Moniteau, Monroe, Montgomery, Morgan, New Madrid, Newton, Oregon, Osage, Ozark, Pemiscot, Perry, Phelps, Pike, Polk, Pulaski, Putnam, Ralls, Randolph, Reynolds, Ripley, St. Charles, St. Francois, St. Louis, Ste. Genevieve, Schuyler, Scotland, Scott, Shannon, Shelby, Stoddard, Stone, Sullivan, Taney, Texas, Warren, Washington, Wayne, Webster, Wright.
MO1 Lab Locality 15 (Western Missouri) = Kansas City plus counties of Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, LaFayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, Worth
Note: Pricing is statewide for Nebraska and Iowa
Medical Nutrition Therapy
The medical nutrition therapy fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exception - The 85% calculation does not apply to Codes G0108 and G0109).
Nurse Practitioner / Physician Assistant / Clinical Nurse Specialist
The NP, PA and CNS fees are available in the Medicare Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exception - The 85% calculation does not apply to codes with a TC modifier, Technical Component Only codes or CPT codes G0108 and G0109)
Splints and Casts
Vaccinations (Influenza (flu) and Pneumococcal)
Note: Administration codes G0008, G0009, G0010, G9141 are priced based on the MPFSDB fee for code 90471.
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