Use the fee schedule’s addendum B to winnow out procedures unsuited for the office

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article is a short practical note for physicians, coders, and billing staff who need to determine whether a service is suitable for a non-facility or office setting. It points readers to Medicare physician fee schedule addenda, MAC guidance, and state policy as sources of reference, and explains the general purpose of reviewing the non-facility practice expense portion of the fee schedule. The piece is relevant for practices comparing office-based service options against Medicare and contractor guidance.

Why This Topic Matters

Office-siting questions can affect whether a practice can furnish a service in its own setting and how Medicare-related payment review is approached. Understanding where to look for official guidance helps practices avoid choosing services that may face coverage or payment challenges.

What You Will Learn

  • Where to look for official guidance on office-based service suitability
  • How Medicare physician fee schedule addenda are used at a high level
  • Why payer and MAC policies matter when evaluating non-facility services
  • What general information the fee schedule’s non-facility practice expense indicators provide

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Practice administrators
  • Compliance staff

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