General Surgery Coding Alert

Question: When I'm looking at the Medicare Physician Fee Schedule (MPFS) to figure out the payment we'll get for our claims, I don't understand what columns to look at. Can you explain what the following column headings mean: non-facility price, facility price, nonfacility limiting charge, and facility limiting charge? Maryland Subscriber Answer: The difference between facility and nonfacility fees is based on where your physician performs services. Medicare will pay you the facility fee whenever your general surgeon does not pay fair market rent for the space, such as in a hospital, ambulatory surgery center, or nursing home. The non-facility fee applies when your surgeon assumes the cost of the space and the personnel at fair market pricing, as in the office. The limiting charge is the maximum amount a physician or practice can charge for a physician's services when the physician does not accept the restrictions on fees established [...]