Utilizing the Medicare Physician Fee Schedule Accurately to Increase Revenue


The Physician Fee Schedule contains valuable information regarding reimbursement and coding for Medicare patients. The Schedule was implemented in January 1992 before which service charges revolved around reasonable and prevailing charges. After the implementation of the schedule, the basis of charging for the services has shifted towards the resource costs that are incurred in providing a specific service. Payment indicators acquired from the schedule are used by many commercial payers in processing claims.

RVUs and its importance to physicians

Relative Value Unit, known in short as RVU, is a value measuring formula which is used by the Medicare program in the United States. This formula is put into use for calculating physicians’ compensations as well as other bonuses. Prior to the use of RVUs, there was great payment variability for physician services. The aim of RVU is to remove these variables from the equation, thereby ensuring proper payment. RVUs hold great importance because they determine how much a physician will be paid for a particular service. Centers for Medicare and Medicaid Services (CMS) assign three values; practice expense RVUs, Work RVUs, and Malpractice expense RVUs, to Current Procedural Terminology (CPT) codes. CPT codes are nothing but numbers which are assigned to services that are provided to patients by physicians. Physician work is measured most of the time using the Work RVUs.

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The Release of PFS, and accessing it

The Physician Fee Schedule gets released in the form of a draft every year under the Proposed Physician Rule and gets finalized in the final rule, which generally happens every October. The PFS can be accessed by medical practices for free at the CMS website. The online search function of the PFS also allows physicians and practices to look up individual codes.

The Significance of the PFS

The Physician Fee Schedule provides the following information:

  • All necessary information regarding days and dates for surgical services.
  • Information regarding diagnostic services, including the breakdown between the professional component and the technical component, as well as the required supervision which are necessary during diagnostic tests.
  • Surgical procedures can be classified into three categories; postoperative, intraoperative and preoperative. The PFS lists the percentage of each category.
  • Practices can get information regarding bilateral procedures. Bilateral surgical procedures are those which require operation on both sides for a particular condition. Reports regarding the presence of an assistant or co-surgeons during a particular surgical procedure can also be accessed.

Medical Billers and Coders follow PFS

Physician Fee Schedule is a great way for physicians to keep themselves updated regarding the services they provide, as well as the dates on which they provide them. This ensures that physicians can claim their payments on time. Medical Billers and Coders (MBC), being the biggest consortium of billing and coding experts in the USA follows the PFS, as it offers great assistance in completing the billing process and therefore, helps doctors and physicians receive the fairest payments and compensations. Following the PFS accurately also makes the billing process slightly easier for the experienced billers at Medical Billers and Coders.

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