Medicare's
Physician Fee Schedule is a valuable resource but can be difficult to interpret. The schedule is a tabular list of all CPT Codes updated yearly by CMS. Codes are listed in rows with details arranged in columns. The most basic information included in the fee schedule is the relative value units (RVUs) assigned to each code, which determine Medicare payment. Additional columns provide detailed facts concerning modifiers, global periods and more. By using this information correctly, practices can increase coding efficiency and accuracy.
Fee Schedule Facts: How to Get It
The updated fee schedule is announced yearly in the Federal Register and can be downloaded from the CMS Web site at
www.hcfa.gov. From the home page, select in order the links for "Stats and Data" (near the top-left of the screen), "Public Use Data Files" (at the top of the screen) and scrolling down under the heading "National Physician Fee Schedule Relative Value File" "RVU02_A.ZIP," scroll to the bottom of the page to accept the CPT copyright statement. To download, select the file, click accept, specify the directory to which you want to save the file (desktop, C-drive, auxiliary drive, etc.) and choose "save."
When the download is complete (this may take 20 minutes or more), use WinZip or other applicable software to open the zipped file. The Fee Schedule (file name "PPRRVU02") is offered in several formats. The Excel (.xls) version is the easiest to use. If you don't have Excel, you can view the information as a text (.txt) file. Double-click on the desired file, which will self-extract for viewing. You may choose to save this extracted file to a new location for easy access later, or you may use WinZip or other applicable software to view the file from its downloaded location each time.
Note: You may also contact CMS directly for a copy by calling 410-786-3000.
RVUs: Checking Medicare Payments
RVU information is helpful because it allows practices to double-check their claim forms to ensure that they are being reimbursed correctly. It can also help in the proper application of modifier -51 (Multiple procedures).
The total RVUs for a procedure are determined by adding the work, practice expense and malpractice expense RVUs, says Susan Callaway, CPC, CPS-C, an independent coding and reimbursement specialist in North Augusta, S.C. Amounts for practice expense and total RVUs are given for facility and nonfacility settings. If there is a facility charge for the service provided (e.g., a hospital, ambulatory surgical center or skilled nursing facility), use the facility RVUs. In all other settings (e.g., the physician's office) nonfacility RVUs are used.
For instance, electromyography (EMG) code 95860 ( one extremity with or without related paraspinal areas) has been assigned 0.96 work RVUs [...]
