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Medicare Physician Fee Schedule Lookup Tool

The Medicare Fee Physician Schedule Lookup Tool (MPFS) is a handy resource that can search for pricing, codes, and payment indicators. This is a list detailing the fees Medicare pays doctors or suppliers. Below we share all the details about the Medicare Fee Schedule Lookup tool including what this tool does, how to find it, and how to use its data.

CMS Medicare Physician Fee Schedule Lookup Tool

The MPFS is a tool the Centers for Medicare and Medicaid Services manages. Also, this tool supports all payment data concerning Medicare and about 10,000 services. Including, everything from Relative Value Units (RVUs), payment policies, and pricing.

Why Do Healthcare Providers Use Searchable MPFS?

This system is the main payment method for all Medicare doctors.

This fee schedule is for these services:

  • Services are done by doctors and other health care workers in private practice
  • Health services under a doctors care
  • Radiology tests
  • Diagnostic services (except clinical lab tests)
  • Health care suppliers receive pay according to the fee schedule

Some of these suppliers can include, Mammography Centers, Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities (CORFs), and Hospital facilities.

The MPFS allows health care suppliers, doctors, and other experts to locate the payment amount for each code. Also, this can find the coinsurance amount.

Although, the MPFS provides a limiting charge to any health care suppliers or doctors who are nonparticipating.

Another benefit of using the MPFS is to decide if Healthcare Common Procedure Coding Systems (HCPCS) impact payment policies; such as the guidance of diagnostic health services by a doctor, the applicability of different modifiers, and payment for an assistant during surgical procedures.

Maximum Fees on Fee-For-Service

Fee schedules are master lists of maximum fees on Fee-For-Service terms to pay health care doctors, suppliers, and other experts. However, the payment decision comes from the lesser of the two; the charges or the MPFS amount

There are even fee schedules for laboratory services, ambulance services, medical equipment, and supplies. Although, you usually only pay 20% of the amount.

Is the Medicare Fee Physician Schedule Lookup Tool Up to Date?

The Medicare Fee Physician Schedule Lookup Tool sees an update every quarter. However, the official date of updating is on the MPFS Overview page.

Where is the Medicare Physician Fee Schedule Located?

The Medicare Fee Physician Schedule Lookup Tool is on the CMS website.

How to Search in the Medicare Physician Fee Schedule

Beginning your search is simple and can be done on the CMS website.

Anyone who uses the Searchable Medicare Physician Fee Schedule can search the following:

  • Pricing Information – This will help provide the maximum fee schedule amount from the HCPCS (Healthcare Common Procedure Coding System) code.
  • Payment Policies Indicators – This is information related to payment policy indicators, like multiple surgery indicators, whether professional and technical components apply and global surgery days.
  • Relative Value Units (RVUs) – This is where a health care expert can find the RVU information on the malpractice and work costs, as well as practice expenses.
  • Geographic Practice Cost Indices (GPCIs) – For the three components of a medical procedure’s RVU, a Geographic Practice Cost Index is available for each payment position.
  • All the above – This option provides data for each of the above types of information.

This tool is available to providers and people of the public. Although, if something is unclear, you can always ask your doctor for assistance.

How to Search the Payment Policy Indicators Tool

Knowing how much you’ll pay before a visit to the doctor can relieve stress. However, the unknown can be a dark and scary place that none of us want to face. With the option to search payment policy indicators you can find things out in advance.

Payment Policy Indicators information can include:

  • The application of either technical or professional modifiers
  • The number of days that are post-operative for a medical procedure
  • Specific code coverage
  • If a medical service can be billed bilaterally
  • The level of supervision by a physician

RVU and GPCI Search

It’s essential to know about Relative Value Units (RVU) and Geographic Practice Cost Indexes (GPCI). Also, there are three parts at play when planning the pricing for every code in the MPFS.

The three components are as follows:

  1. Work Relative Value Units – This shows both intensity and time with providing services and is equivalent to about 50 percent of the total payment.
  2. Practice Expense (PE) Relative Value Units – These show costs like purchasing any supplies and medical equipment, costs for employing staff members, and even renting office space.
  3. Malpractice (MP) Relative Value Units – This shows the cost of purchasing malpractice insurance.

The GPCI’s provide the approximate costs of malpractice and practice expenses, and the costs of doctors work in a specific region in relation to the average costs nationwide.

Conversion Factor tools receive an annual update. Up until 2015, this annual update was similar to the Medicare Economic Index (MEI) and was reliant upon how costs compare to the Sustainable Growth Rate (SGR). In 2019, the conversion factor increase was about $0.04 from 2018. This means most sleep procedures and evaluations will receive a slight pay increase.

Medicare Physician Fee Schedule Final Rule

By reducing the amount of paperwork doctors need to complete, more time is spent with patients. The Medicare Physician Fee Schedule is a helpful tool for everyone. If you’re on Medicare or know someone with this coverage, share these resources.

For those looking for help paying the out-of-pocket cost-sharing with Medicare; our agents can walk you through the process of obtaining supplemental Medicare coverage. Give us a call at the number above or fill out our online rate comparison form.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.


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