Medicare Fee Schedule

The way Medicare fees are established is extremely complex.  To determine the reimbursement amount for each procedure (or CPT code), a conversion factor is multiplied by the relative value units (RVUs) that have been assigned to that procedure, and then an adjustment is made based on the geographic location of the practice.  The number of RVUs assigned to a procedure is based on three elelments:  the work required for the procedure, the practice expense incurred for the procedure, and the cost of the provider's professional liability insurance.

Members may contact the APA's Managed Care HelpLine by phone 800.343.4671 or email hsf@psych.org with questions.

2010 Medicare Fee Schedule UPDATE

[posted 6.26.2010]  On 25 June President Obama signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010—2.2 Percent Medicare Physician Fee Schedule Update retroactive from June 1, 2010 Through November 30, 2010.

  • CMS has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. 
  • CMS expects to begin processing claims at the new rates no later than July 1, 2010.
  • Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
  • Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.

Important note:  Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount.  Therefore:

  • Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.
  • Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.
  • Submitted charges on claims cannot be altered without a request from the physician/provider.
  • Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Related Member advice for billing Medicare.


2009 Medicare Fee Schedule

2008 Medicare Fee Schedule