Medicare Physician Fee Schedule Part B
January - 2024
This fee was accessed on using the Palmetto GBA Medicare Fee Schedule Part B Lookup Tool.
CMS updates and corrects fees often, which may mean the information below is out of date.
You should always used the most up-to-date fee schedules, which are available online at: http://palmettogba.com/medicare
Our Palmetto GBA Medicare Physician Fee Schedule (MPFS) tool allows you to display or download fees, indicators, and indicator descriptors.
Start by selecting your fee's year in the box below. As you answer questions, new ones will appear to guide your search.
Use the "Clear" button to change the year or contractor.
For more assistance with this tool, visit our Help page 
. You can find additional information on the CMS Physician Fee Schedule page.
| Fee Schedule Lookup
Fields with an asterisk (*) are required
|
|
|
|
Display Procedure Code/Disclosures on Screen
SC NC VA WV AL GA 01 GA 99 TN
Display Fees For Up to Five Procedure Codes
SC NC VA WV AL GA 01 GA 99 TN
Download Physician Fee File/Disclosures
SC NC VA WV AL GA 01 GA 99 TN
Download Indicator File
SC NC VA WV AL GA 01 GA 99 TN
Download Contractor File
SC NC VA WV AL GA 01 GA 99 TN
|
|
|
|
NOTE: Medicare Physician Fee Schedules Part B Disclosure is only downloadable for AL. GA, TN, NC, SC, WV, and VA. All other states are viewable only. |
|
|
|
Recent Codes:
|
|
|
| |
|
By clicking “Submit” you confirm that you have read and accept the license agreement. Users are required to read and accept this license agreement prior to using the Medicare Physician Fee Schedule Part B.
Note for Mobile Users:
Fee and indicator files are quite large. To avoid cellular data charges and download errors, we strongly recommend you only download while connected to a stable Wi-Fi connection.
|
|
By clicking “Download Disclosure” you confirm that you have read and accept the license agreement. Users are required to read and accept this license agreement prior to using the Medicare Physician Fee Schedule Part B.
Note for Mobile Users:
Fee and indicator files are quite large. To avoid cellular data charges and download errors, we strongly recommend you only download while connected to a stable Wi-Fi connection.
|
|
By clicking “Download Indicator File” you confirm that you have read and accept the license agreement. Users are required to read and accept this license agreement prior to using the Medicare Physician Fee Schedule Part B.
|
|
By clicking “Download Contractor File” you confirm that you have read and accept the license agreement. Users are required to read and accept this license agreement prior to using the Medicare Physician Fee Schedule Part B.
|
|
|
Your search returned multiple results. Please select the effective date for your code from the table below:
|
Notes
N.
|
Proc. Code
P.
|
Modifier
Mod
|
Par Fee
Par
|
Non-Par Fee
Non-Par
|
Limiting Charge
Limit.C
|
eRx-Limiting Charge ***
eRx ***
|
Effective Date
E
|
|
# - These amounts apply when services is performed in a facility setting
C - The payment for the technical component is capped at the OPPS amount
Limiting charge applies to unassigned claims by non-participating providers (Disclosures)
*** - Limiting charge reduced based on status is an unsuccessful e-prescriber per the Electronic Prescribing (eRx) Incentive Program
|
|
Proc. Code & Modifier
P.
|
Par Fee
Par
|
Non-Par Fee
Non-Par
|
Limiting Charge
Limit.C
|
EHR Limiting Charge**
|
PQRS Limiting Charge***
|
EHR/2014 eRx-Limiting Charge**
|
EHR+PQRS Limiting Charge****
|
EHR/2014 eRx+PQRS Limiting Charge****
|
Effective Date
E
|
* Click on a row to view additional information about the Procedure Code
# - These amounts apply when services is performed in a facility setting.
C - The payment for the technical component is capped at the OPPS amount.
Limiting charge applies to unassigned claims by non-participating providers.
You have requested information outside of Palmetto GBA’s jurisdictional area. While the information we provide is based on our most current Medicare Physician Fee Schedule Part B Database Files, Palmetto GBA disclaims any responsibility for content provided for states outside the JM Jurisdictional area (North Carolina, South Carolina, Virginia and West Virginia), and your continued use of this website constitutes your acceptance of this disclaimer. If you have questions regarding the information provided for states outside our jurisdictional area, please contact the respective MAC contractor(s) for the area.
| Schedule |
| Effective Date: |
- |
Locality: |
- |
| State: |
- |
Modifier: |
- |
| Procedure Code |
- |
|
|
| Description: |
- |
| Schedule |
| File Creation Date: |
- |
Effective Date: |
- |
| State: |
- |
Locality: |
- |
| Procedure Code |
- |
Modifier: |
N/A |
| Description: |
- |
| Fees |
Non-Facility |
Facility |
OPPS Cap
Non-Facility |
OPPS Cap
Facility |
Reduced Therapy |
| Participating Amount: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Non-Participating Amount: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Limiting Charge Amount: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| eRx Limiting Charge: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| PQRS Limiting Charge: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| EHR/ 2014 eRx-Limiting Charge: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| EHR + PQRS Limiting Charge: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| EHR/2014 eRx + PQRS Limiting Charge: |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
| Schedule |
| File Creation Date: |
- |
| Effective Date: |
- |
| State: |
- |
| Locality: |
- |
| Procedure Code |
- |
| Modifier: |
N/A |
| Description: |
- |
| Fees |
Non-Facility |
Facility |
| Participating Amount: |
- |
- |
| Non-Participating Amount: |
- |
- |
| Limiting Charge Amount: |
- |
- |
| eRx Limiting Charge: |
- |
- |
| OPPS Cap Fees |
Non-Facility |
Facility |
| Participating Amount: |
$0.00 |
$0.00 |
| Non-Participating Amount: |
$0.00 |
$0.00 |
| Limiting Charge Amount: |
$0.00 |
$0.00 |
| eRx Limiting Charge: |
$0.00 |
$0.00 |
| Reduced Therapy Fees |
| Participating Amount: |
$0.00 |
| Non-Participating Amount: |
$0.00 |
| Limiting Charge Amount: |
$0.00 |
| eRx Limiting Charge: |
$0.00 |
| Indicators
Display Indicator Descriptor Page |
| Status: |
- |
|
| Site of Service: |
- |
|
| Professional/Technical Component: |
- |
|
| Multiple Procedure: |
- |
|
| Bilateral Surgery: |
- |
|
| Assistant at Surgery: |
- |
|
| Team Surgeons: |
- |
|
| Co Surgeons: |
- |
|
| Physician Supervision of Diagnostic Procedures: |
- |
|
| Anti-Markup Test Indicator: |
- |
|
| Surgery Information |
| Global Days: |
- |
|
| Pre-Operative %: |
- |
|
| Intra-Operative %: |
- |
|
| Post-Operative %: |
- |
|
| Endoscopic Base Code: |
N/A |
|
| Diagnostic Imaging Indicator: |
- |
|
| Conversion Factor: |
- |
|
| Update Factor: |
- |
|
| Imaging Cap Indicator: |
- |
|
| P4P Indicator: |
- |
|
| Relative Value Units |
| Work: |
- |
|
| Malpractice: |
- |
|
| Facility Settings: |
- |
|
| Non Facility Settings: |
- |
|
| Geographic Practice Cost Indices |
| Work: |
- |
|
| Practice: |
- |
|
| Malpractice: |
- |
|
Note: Payments for the technical component of a code are capped at the OPPS amounts. The Non-Participating, and Limiting Charge amounts listed are based on the lower of the fee schedule amount and the OPPS payment caps.
Note: Payments for the technical component of a code are capped at the OPPS amounts. The Non-Participating and Limiting Charge amounts listed are based on the lower of the fee schedule amount and the OPPS payment caps.
Note: Payments for the technical component of a code are capped at the OPPS amounts. The Non-Participating, Limiting Charge and eRx Limiting Charge amounts listed are based on the lower of the fee schedule amount and the OPPS payment caps.
Note: The fees shown above are based on formulas used by the Medicare Shared System Maintainer. Due to rounding, you may see a one cent ($0.01) difference in the limiting charge amounts above compared to the CMS physician fee schedule lookup tool.
Note: An allowable amount for an item or service does not imply Medicare coverage. A fee schedule amount is shown for each procedure code listed in the Medicare Physician Fee Schedule Part B database. Based on Medicare policy, however, the specific procedure may not be payable by the Medicare program. Services with a Status indicator = C or R are priced by Palmetto GBA and may be payable subject to supporting documentation.
All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2022 by The American Medical Association.
All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2023 by The American Medical Association.
The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2023 American Dental Association (ADA). All rights reserved