Medicare Physician Fee Schedule Lookup Tool

The Medicare Physician Fee Schedule Lookup Tool (MPFS) is a handy resource for searching for pricing, codes, and payment indicators for Medicare-approved services.

Read on to learn how to perform a Medicare fee schedule lookup – including how it works, where to find your information, and how to use the data provided by the MPFS lookup tool.

What is the Medicare Fee Schedule?

The Medicare Fee Schedule is a comprehensive list of the fees Medicare will use to pay professionals in the healthcare industry, such as physicians, specialists, medical suppliers, etc.

A physician fee schedule for Medicare will contain the maximum amount of a fee Medicare reimburses for a number of medical expenses such as medical supplies, ambulance services, work done by a physician, etc.

This is why the Medicare Fee Schedule Lookup Tool is so important. It can help you better understand the fees and charges associated with your healthcare.

Is the 2023 Medicare Fee Schedule Available?

The 2023 Medicare Physician Fee Schedule and Quality Payment Program (QPP) are available as of July 7, 2022, through the Centers for Medicare & Medicaid Services (CMS).

CMS Medicare Physician Fee Schedule Lookup Tool

CMS manages the MPFS tool, providing a detailed list of the fees Medicare pays doctors or suppliers for visits, tests, and procedures.

The Medicare Fee Schedule Look Up tool also provides information about over 10,000 physician services, related codes, fees, and adjusted payments supplied by Medicare.

A Medicare Physician Fee Schedule includes a variety of fee schedules, including those for laboratory services, ambulance services, medical equipment, and supplies.

However, it’s important to note you typically only pay 20% of the amount shown on the CMS Fee Schedule Lookup tool.

Why Do Physicians Use Searchable MPFS?

Physician Fee Schedules are the master list of fees and the primary payment method for all Medicare-accepting doctors and facilities. So, if your doctor accepts Medicare assignment, they must follow the fee schedule.

The fee schedule found in a Physician Fee Schedule Lookup includes any health services provided by suppliers, doctors, and other healthcare providers in hospital-based and private practice.

Suppliers can consist of mammography centers, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), and hospital facilities.

When using a Private-Fee-For-Service plan, your determined payment will be the lesser of the amount or the doctor’s agreed charges through a Medicare Physician Fee Schedule Lookup tool.

Therefore, it is important to check the MPFS tool to ensure you are not overpaying for services. Your doctor should have this information available in their office, however, it is important to have first-hand knowledge of the fee schedule.

How Does Medicare Determine Its Fee for Service Reimbursement Schedules?

Using a resource-based relative value system (RBRVS), the Medicare Physician Fee Schedule assigns relative values to current procedural terminology (CPT) codes.

Various professional healthcare organizations and societies help contribute input to the AMA’s Resource Based Relative Value System (RBRVS).

A relative weighting factor (RVU) comes from a resource-based relative value scale featuring many components of the RBRVS, including professional, technical, and professional liability.

CMS will create the final RVU for each code. This code is multiplied by the dollar amount (the annual conversion factor), giving us the national average fee.

Provider locality determines rate adjustments. There may be a higher or lower conversion factor applied by payers other than Medicare when adopting these relative values.

Changes in the 2023 Medicare Fee Schedule Lookup Tool

How often is the Medicare Physician Fee Schedule (MPFS) updated?

Each quarter, the MFPS tool is updated to reflect changes in codes, fees, or coverage. Changes are found on CMS.gov in the MPFS overview. So, it is important to check the tool regularly to ensure changes have not occurred.

Additionally, every year, Medicare issues a Final Rule that takes effect the following year. The biggest takeaways from a recent Final Rule from Medicare, according to CMS, are as follows:

• Inpatient prospective payment system rates are updating by 2.6% in 2023 compared to 2022. This increase is due to a 4.1% market basket update, a 0.3% reduction in productivity, plus 0.5% as required by statute.
• The Final Rule also states that a 1.7% cut is coming because of outlier payments.
• Changes will also include CMS finalizing a decrease of disproportionate share hospital payments totaling $300 million, new medical technology payments totaling $750 million, and enhanced Low-Volume Hospital and Medicare Dependent Hospital payments totaling $600 million. The decrease stems from the statutory expiration of each of these programs.

How Do I Find My Medicare Fee Schedule?

Using the tool is simple, and instructions are easy to follow. To begin your search, open the Medicare Physician Fee Schedule Lookup Tool from CMS and choose your desired search type. Search results populate when all required fields are complete.

All search types on the MPFS lookup tool are available to healthcare professionals and the public to ensure transparency in all medical practices.

Therefore, if you are unclear about the search results, you can always ask your doctor for assistance, or you can consult this instructional pamphlet provided by The Medicare Learning Network®.

Utilizing MPFS Tool Search Options

When using the Medicare Physician Fee Schedule Lookup tool, it is important to filter your search results to give you the information you need rather than all the information the tool provides to reduce confusion.

Here are some key things you’ll want to understand while assessing your search results while using the Medicare Fee Schedule Lookup tool:

• Pricing Information helps provide the maximum fee schedule amount from the HCPCS code. You can obtain this from your healthcare provider or facility.
• Payment Policy Indicators help give you a clearer picture of your exact costs for specific tests and procedures. This is an advanced search option that requires additional information to complete. Search results can include specific code coverages, level of supervision by a physician, number of days post-op that receive coverage, and any additional modifiers that could affect cost.
• Relative Value Units (RVUs) help medical professionals find information regarding malpractice and work costs, as well as practice expenses. RVU’s show the costs of supplies, medical equipment, time, malpractice insurance, and operating room fees. These costs are important to understand as they can be equivalent to about 50% of the total payment. You can use an RVU calculator to analyze these units with their respective codes.
• Geographic Practice Cost Indices show the differences in cost across different regions in the United States. This search option pulls RVU’s and compares them regionally and nationally to show areas where procedures are more cost-effective.

How To Find the Medicare Physician Fee Schedule Lookup Tool

Many pages on the web state they have an MPFS tool for Medicare beneficiaries. However, to ensure you are using the most up-to-date version, visit CMS.gov for the official Medicare Physician Fee Schedule Lookup tool.

For those looking for help with paying the out-of-pocket costs that come with Medicare, our licensed agents can walk you through the process of obtaining supplemental Medicare coverage. To reach a Medicare expert, fill out our online rate form, or speak to an agent today by giving us a call at the number above.

From helping seniors utilize the Medicare Physician Fee Schedule Lookup tool to providing them with the right coverage options, we are your go-to resource for all things Medicare.