decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 15006 / 15006
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Article Overview
This article covers Medicare fee schedule computation methodology, including the roles of RVUs, geographic practice cost indices, and the national conversion factor. It also discusses the transition from charge-based to resource-based practice expense values for 1999–2002, the handling of services without CMS-provided relative values, and guidance for services with professional and technical components. The material is relevant to Medicare billing and reimbursement staff, physicians, and coding professionals who need to understand how fee schedule amounts are determined and what categories of services are treated differently under CMS pricing policy.
Why This Topic Matters
Understanding this section helps readers interpret Medicare fee schedule payment methodology and recognize which service categories are priced differently or require special handling. It is especially useful for organizations that manage Medicare reimbursement, carrier pricing, and coding support for services affected by RVU-based payment rules.
Article Sections
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Method for Computing Fee Schedule Amount
Explains the general Medicare fee schedule calculation framework, including the components used in the formula and the annual conversion factors referenced for multiple years. It also notes the transition of practice expense values during the early 2000s and includes an illustrative payment computation example.
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No CMS RVUs
Describes service categories for which CMS does not provide relative values and outlines the broad treatment of services paid on a report-based or carrier-priced basis. It also addresses how the manual distinguishes certain national and local services for fee schedule purposes.
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Diagnostic Procedures and Other Codes With Professional and Technical Components
Summarizes guidance for services that have both professional and technical components and indicates that CMS determines which HCPCS codes are classified in this category.
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No Special RVUs for Limited License Practitioners
States that fee schedule relative values are not separately adjusted for limited license practitioners and briefly references billing considerations involving physical therapy services and related procedure codes.
What You Will Learn
- How Medicare fee schedule amounts are structured at a high level
- How practice expense values changed during the 1999–2002 transition period
- What broad categories of services may not have CMS-provided relative values
- How CMS treats services with both professional and technical components
- How the manual addresses limited license practitioners in fee schedule payment
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Medicare reimbursement specialists
- Physicians and group practices
Codes Discussed
Code Ranges Discussed
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