Medicare Fee Schedule
The way Medicare fees are established is extremely complex. To determine the reimbursement amount for each procedure (or CPT code), a conversion factor is multiplied by the relative value units (RVUs) that have been assigned to that procedure, and then an adjustment is made based on the geographic location of the practice. The number of RVUs assigned to a procedure is based on three elelments: the work required for the procedure, the practice expense incurred for the procedure, and the cost of the provider's professional liability insurance.
Members may contact the APA's Managed Care HelpLine by phone 800.343.4671 or email hsf@psych.org with questions.
2011 Medicare Fee Schedule
The Medicare Extender Act of 2010 stabilized Medicare physician payments at 2010 rates through the end of 2011.
In addition to providing a 12-month reprieve from the 25 percent Medicare physician payment cut that was scheduled to take effect on January 1, 2011, the law extended the 5% increase in payments for psychotherapy codes that first went into effect in 2008, and was retroactively reinstated for 2010 as part of the health reform legislation passed in March 2010.
Although the bill essentially extended the 2010 fee schedule, there may be some changes in fees allowed for specific procedures because of adjustments made tohe conversion factor, work values of the codes, etc.
It is vital to check your Medicare Contractor's website to be sure you have the correct 2011 fees.
The AMA has more information about this at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding:billing-insurance/medicare/payment-action-kit-medicare.shtml
Related Member advice for billing Medicare.
2010 Medicare Fee Schedule
2009 Medicare Fee Schedule
2008 Medicare Fee Schedule