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CMS offers an online Medicare Fee Schedule Lookup tool to access the fee schedule, and the public or medical providers may access this tool.
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When healthcare providers accept Medicare Assignment, they agree to conform to Medicare's allowed charges and will follow the fee schedule referenced in MPFS tool.
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Medicare publishes fees for thousands of medical services on the Medicare Physician Fee Schedule.
When health providers accept Medicare Assignment, they agree to receive the Medicare-approved amount of money as payment for their services. The Medicare Physician Fee Schedule lists tens of thousands of services and the amount Medicare considers fair compensation. The government also offers a handy Medicare Fee Schedule Lookup tool to research these fees online. Medical providers and the public can access this tool.
What is the Medicare Physician Fee Schedule?
The Medicare Physician Fee Schedule’s (MPFS) name sounds slightly misleading. In addition to doctor’s charges, the list also includes fees for thousands of other covered services, including lab tests, medical equipment, ambulance rides, etc.
When Original Medicare covers various services at a specific percentage, it only pays that portion of the Medicare-approved amount, as found on the MPFS. If a Medicare provider says that they accept Medicare Assignment, they agree to adhere to this schedule of fees.
How Does the Medicare Fee Schedule Lookup Tool Work?
The Centers for Medicare and Medicaid Services (CMS) manages an online tool that medical providers and the public can use to learn Medicare-assigned fees for tens of thousands of services.
For instance:
- Doctors can use the tool to determine how much they can charge to conform to Medicare guidelines.
- Medicare beneficiaries might find the tool useful to help estimate their share of the cost if they need to pay coinsurance or a copay. For a Part B service covered at 80%, beneficiaries who only have Original Medicare might estimate they will need to pay 20% of the published fee.
- As another example, beneficiaries can proactively compare provider charges against Medicare’s assigned fee to ensure the provider conforms to Medicare guidelines.
CMS’s overview page for the Medicare Physicians Fee Schedule offers more information about the fee schedule and the online tool. To get started with the lookup tool, click the blue “Begin Search” button at the bottom of the page and follow simple instructions.
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