1. What is the Medicare Fee Schedule?

The Medicare Fee Schedule determines how much providers get paid for services covered under Medicare Part B. It's based on the Resource-Based Relative Value Scale (RBRVS) which assigns relative value units (RVUs) to services.

2. How Does the Calculator Work?

The calculator uses the Medicare Fee Schedule equation:

Where:

• \( CF \) — Conversion Factor (dollars per RVU)
• \( wRVU \) — Work Relative Value Unit
• \( PE\ RVU \) — Practice Expense Relative Value Unit
• \( MP\ RVU \) — Malpractice Relative Value Unit
• \( GPCI \) — Geographic Practice Cost Index

Explanation: The equation accounts for the physician work, practice expenses, and malpractice costs, adjusted for geographic variations in costs.

3. Importance of Medicare Fee Calculation

Details: Understanding the fee schedule helps providers estimate reimbursement, analyze practice economics, and make informed decisions about service offerings.

4. Using the Calculator

Tips: Enter all required values (CF, wRVU, PE RVU, MP RVU, and GPCI). All values must be positive numbers. The calculator will compute the estimated Medicare fee for the service.

5. Frequently Asked Questions (FAQ)

Q1: Where can I find the RVU values for specific CPT codes?
A: The Centers for Medicare & Medicaid Services (CMS) publishes RVU values annually in the Medicare Physician Fee Schedule.

Q2: How often does the conversion factor change?
A: The CF is updated annually by CMS, though mid-year changes can occur due to legislative actions.

Q3: What's the typical range for GPCI values?
A: GPCI values typically range from about 0.8 to 1.2, with 1.0 being the national average.

Q4: Are there services not paid under this fee schedule?
A: Yes, some services like vaccines and certain preventive services have separate payment methodologies.

Q5: How accurate is this calculator for actual reimbursement?
A: This provides the base fee calculation, but actual payments may be affected by modifiers, sequestration, and other adjustments.