Fee Schedules


Palmetto GBA adjudicates claims based on the Medicare fee schedules and guidelines set forth by the Centers for Medicare & Medicaid Services (CMS).


The durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) fee schedules contain fee schedule amounts, floors and ceilings for each procedure code subject to the DMEPOS fee schedule payment methodology.
 

Outpatient clinical laboratory services are paid based on a fee schedule in accordance with Section 1833(h) of the Social Security Act. Payment is the lesser of the amount billed, the local fee for a geographic area, or a national limit. In accordance with the statute, the national limits are set at a percent of the median of all local fee schedule amounts for each laboratory test code. Each year, fees are updated for inflation based on the percentage change in the Consumer Price Index. However, legislation by Congress can modify the update to the fees.
 

Medicare Part B pays for physician services based on the Medicare Physician Fee Schedule (MPFS), which include office visits, surgical procedures, anesthesia services, and a range of other diagnostic and therapeutic services.

You can verify the Medicare Physician Fee Schedule allowed amount for your state and locality using the Medicare Physician Fee Schedule Tool, which allows you to display or download fees, indicators and indicator descriptions.





Fee Schedules Articles


2020 West Virginia Ambulatory Surgical Center (ASC) Fee Schedules2021 Ambulance Fee ScheduleJuly 2020 Update: Virginia Ambulatory Surgical Center (ASC) Fee SchedulesApril 2020 Update: South Carolina Ambulatory Surgical Center (ASC) Fee SchedulesJuly 2020 Update: South Carolina Ambulatory Surgical Center (ASC) Fee Schedules2020 Virginia Ambulatory Surgical Center (ASC) Fee SchedulesOctober 2020 Update: North Carolina Ambulatory Surgical Center (ASC) Fee SchedulesJuly 2019 West Virginia Ambulatory Surgical Center (ASC) Fee Schedule Update2021 Virginia Ambulatory Surgical Center (ASC) Fee SchedulesJuly 2019 North Carolina Ambulatory Surgical Center (ASC) Fee Schedule UpdateJuly 2020 Update: West Virginia Ambulatory Surgical Center (ASC) Fee SchedulesOctober 2020 Update: South Carolina Ambulatory Surgical Center (ASC) Fee Schedules2019 Ambulatory Surgical Center (ASC) Drug Pricing UpdatesJuly 2019 Virginia Ambulatory Surgical Center (ASC) Fee Schedule UpdateOctober 2020 Update: Virginia Ambulatory Surgical Center (ASC) Fee SchedulesApril 2020 Update: North Carolina Ambulatory Surgical Center (ASC) Fee SchedulesOctober 2020 Update: West Virginia Ambulatory Surgical Center (ASC) Fee SchedulesJuly 2019 South Carolina Ambulatory Surgical Center (ASC) Fee Schedule UpdateApril 2020 Update: Virginia Ambulatory Surgical Center (ASC) Fee SchedulesApril 2020 Update: West Virginia Ambulatory Surgical Center (ASC) Fee Schedules2020 Ambulance Fee ScheduleHow to Use the Searchable CMS Medicare Physician Fee Schedule (MPFS)2021 West Virginia Ambulatory Surgical Center (ASC) Fee SchedulesJuly 2020 Update: North Carolina Ambulatory Surgical Center (ASC) Fee Schedules2021 South Carolina Ambulatory Surgical Center (ASC) Fee Schedules2020 South Carolina Ambulatory Surgical Center (ASC) Fee Schedules2021 North Carolina Ambulatory Surgical Center (ASC) Fee SchedulesHome Infusion Therapy (HIT) RatesCompounded Drug FeesAmbulatory Surgical Center Core Based Statistical Areas (CBSA) CodesPricing Updates for Percutaneous Ateriovenous Fistual (AVF) CreationRevised Fees for Transurethral Waterjet AblationHow Does Palmetto GBA Use Invoices to Reimburse Drugs and Biologicals?2021 Ambulatory Surgical Center (ASC) Drug Pricing Updates2020 Ambulatory Surgical Center (ASC) Drug Pricing UpdatesPricing Updates for Home Sleep Study (HST) for Jurisdiction MHemophilia Clotting Factors: Submitting the Number of UnitsInfluenza and Pneumococcal Vaccines and Administration ReimbursementFee for High Energy Shock Wave Therapy for Wound TreatmentCMS Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule Fact SheetPhysician Fee Schedule Lookup Tool