Verify your payment accuracy and analyze new payer proposals
The fee schedule calculator tool assists you in pulling and exporting a CMS physician fee schedule based on a specific calendar year, which allows you to quickly reference the Medicare payment rate for any procedure code performed at your facility. The tool also allows you to select a percent of Medicare (e.g., 125%) to assist with analyzing a non-Medicare payment rate.
This non-Medicare payment rate can be set to align with an insurance payer contract or proposed future rate. You can then use it to verify whether payments received are accurate or to determine whether a proposed payment rate will meet your expectations. The tool also allows you to select either facility or nonfacility in the drop-down menu to determine reimbursement, depending on where the services were provided.
Instructions for use:
- Select a CMS fee schedule year/version.
- Select your locality (Please note: GPCI neutral is the national fee schedule with no geographic adjustment).
- Select "Facility" or "Nonfacility" for the service location
- Select a “Percent of Medicare” for the non-Medicare adjusted fee schedule rate that will be displayed.
- Click “Calculate Fee Schedule” before you click "Export to Excel."