Medicare Fee Schedule

The Medicare fee schedule is the entire listing of fees Medicare uses to pay doctors, clinics, ambulances, and suppliers.

The list of maximum fees is used to pay Medicare providers on a fee-for-service basis.

Medicare provides fee schedules for the following providers:

Ambulance Fee Schedule - There is a national fee schedule for ambulance service provided as a benefit under Medicare Part B.

The ambulance fee schedule applies to all ambulance services, including municipal, independent, private, volunteer, institutional providers, and skilled nursing facilities.

Ambulance providers and suppliers have to accept the Medicare allowed charge as payment in full. The ambulance providers agree not to bill or collect any amount other than any unmet Medicare Part B deductible and Medicare Part B coinsurance amounts.

Clinical Laboratory Fee Schedule - Payment for outpatient clinica lab services is the lesser of the amount billed, the local fee for a geographic area, or the national limit. The national limits are set for each lab test code at a percent of the median for for all local fee schedule amounts. Every year, those fees are adjusted for inflation based on the Consumer Price Index. Deductibles and co-payments do not apply under the Medicare clinical laboratory fee schedule.

Critical access hospitals and hospitals with less than 50 beds in qualified rural areas are paid for outpatient lab tests on a reasonable cost basis instead of the fee schedule.

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule (DMEPOS) - Medicare payment for these supplies is equal to 80 percent of the lower of the actual charge for the item or the fee schedule amount for the item minus any unmet deductible.

The equipment and supplies that are covered by DMEPOS include durable medical equipment, prosthetics and orthotics, parenteral and enteral nutrition, and theraputic shoes and inserts.

Physician Fee Schedule - Payments to physicians that provide medical services to Medicare patients. At the present time, these Medicare payments are scheduled to decrease by 23 percent in December of 2010 and an additional decrease of 6.5 percent by January 1, 2011.

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The official U.S. Government Medicare Web site is Medicare.gov.