Medicare Part B Fee Schedule

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.

A PRA package for the renewal of the ASP Data Collection Instrument CMS-10110 OMB-0938-0921 is currently under review and the 60-Day FR Notice for collection CMS-10110 has been published to the Federal Register (88 FR 7446) as of February 3, 2023 and is set to end April 4, 2023. The ASP Data Collection Instrument is used to report quarterly ASP reports in accordance with reporting requirements in 42 CFR Part 414 Subpart J. The reported ASP data are used to establish the Medicare payment amounts for many Part B drugs. Comments can be submitted at -02267/agency-information-collection-activities-proposed-collection-comment-request

A list of drugs that must be reported in units other than NDCs is posted in the Downloads section. More information is available in the 2012 physician fee schedule final rule (76 FR 73296-8, November 28, 2011).

Section 303(c) of the Medicare Modernization Act of 2003 (MMA) revised the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amended Title XVIII of the Act by adding section 1847A, which established a new average sales price (ASP) drug payment system. Beginning January 1, 2005, drugs and biologicals not paid on a cost or prospective payment basis will be paid based on the ASP methodology, and payment to the providers will be 106 percent of the ASP. There are exceptions to this general rule which are listed in the Medicare Claims Processing Manual, Pub. 100-04, Chapter 17. The ASP methodology uses quarterly drug pricing data submitted to the CMS by drug manufacturers. CMS will supply contractors with the ASP drug pricing files for Medicare Part B drugs on a quarterly basis.

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A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This page provides comprehensive listings of fee maximums used to reimburse physicians/practitioners, ambulance suppliers, clinical laboratories, ambulatory surgery centers, drugs/biologicals, and other providers on a fee-for-service basis. The various types of fee schedules are available to view and/or download. Select the fee schedule option below.

Audiology and speech-language pathology services under Medicare Part B (outpatient) have reimbursement rates established by the MPFS regardless of provider setting, except for outpatient audiology services provided in hospitals. ASHA provides information on the MPFS for audiologists and SLPs, including in-depth analysis of relevant policy changes and revisions to the fee schedule, Medicare Part B payment rules, geographic adjustment calculations, and new developments each calendar year. The Centers for Medicare & Medicaid Services (CMS) updates the fee schedule annually for implementation on January 1.

If you have elected to be a participant during 2023, the limiting charges indicated on the report will not pertain to your practice. The non-participating fee schedule amounts and limiting charges do not apply to services or supplies unless they are paid under the physician fee schedule. Limiting charge applies to unassigned claims by non-participating providers. All services provided to Medicare beneficiaries are subject to audit and documentation requirements.

If you have elected to be a participant during 2022, the limiting charges indicated on the report will not pertain to your practice. The non-participating fee schedule amounts and limiting charges do not apply to services or supplies unless they are paid under the physician fee schedule. Limiting charge applies to unassigned claims by non-participating providers. All services provided to Medicare beneficiaries are subject to audit and documentation requirements.

If you have elected to be a participant during 2021, the limiting charges indicated on the report will not pertain to your practice. The non-participating fee schedule amounts and limiting charges do not apply to services or supplies unless they are paid under the physician fee schedule. Limiting charge applies to unassigned claims by non-participating providers. All services provided to Medicare beneficiaries are subject to audit and documentation requirements.

As part of the resource-based practice expense initiative, CMS has replaced the previous policy that systematically reduced the practice expense relative value units (RVUs) by 50%for certain procedures performed in facilities with a policy that would generally identify two different levels (facility and non-facility) of practice expense RVUs for each procedure code depending on the location of the service.

Payment may be made for services furnished by nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNs) in all settings permitted by state law, but only if no facility or other provider charges are paid in connection with the service. Payment would be equal to 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule. Payment for a PA's services may only be made to the PA's employer. Under certain circumstances, a PA as an independent contractor qualifies as an employment relationship where payment is made to the employer.

Some practitioners who provide services under the Medicare program are required to accept assignment for all Medicare claims for their services. This means that they must accept the Medicare allowed charge amount as payment in full for their practitioner services. The beneficiary's liability is limited to any applicable deductible plus the 20 percent coinsurance. The following practitioners must accept assignment for all Medicare covered services they furnish, and carriers do not send a participation enrollment package to these practitioners. The non-participating fee schedule amounts and limiting charges do not apply to services rendered by:

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