Physician Fee Schedule

CY 2013 Physician Fee Schedule Final Rule with Comment period
The CY 2013 PFS final rule with comment period was placed on display at the Federal Register on November 1, 2012.  The final rule with comment period addresses changes to the physician fee schedule, payments for Part B drugs, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also implements provisions of the Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items. In addition, it implements statutory changes regarding the termination of non-random prepayment review. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs.

The MPFS Conversion Factor for CY 2013 is $34.0230, which reflects the zero percent update for calendar year 2013 adopted by section 601(a) of the American Taxpayer Relief Act of 2012 and MPFS payment rates reflecting policies adopted in the CY 2013 Medicare Physician Fee Schedule Final Rule that appeared in the Federal Register on November 16, 2012, as subsequently corrected by a CY 2013 Medicare Physician Fee Schedule Final Rule Correction Notice.

CY 2013 Physician Fee Schedule Proposed Rule
The CY 2013 PFS proposed rule was placed on display at the Federal Register on July 6, 2012. The proposed rule includes proposed annual updates to the relative weights of physician services and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services.

CY 2012 Physician Fee Schedule Final Rule Correction Notice
The CY 2012 PFS final rule correction notice was published in the Federal Register on January 4, 2012. The correction notice corrects technical errors and typographical errors in the final rule with comment period entitled ‘‘Medicare Program; Payment Policies under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012'' which appeared in the November 28, 2011 Federal Register.

CY 2012 Physician Fee Schedule Final Rule With Comment Period
The CY 2012 PFS final rule with comment period was placed on display at the Federal Register on November 28, 2011. The final rule with comment period addressed changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. The final rule with comment period implemented or discussed certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discussed payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

The final rule with comment period was published in the November 28, 2011 Federal Register, and the comment period closed on January 3, 2012.

Calculating Payment Amounts

The formula for calculating 2012 physician fee schedule payment amount is as follows:

2012 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2012 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * CF

The conversion factor for CY 2012 is $34.0376.

The information that is provided on the physician fee schedule (PFS) web page relates to payment under the PFS and related information concerning the development of the payment amounts.  This information is intended for physicians/non-physicians who provide services to Medicare beneficiaries.  This information is updated on regular basis when there are payment/policy changes.

Physician Fee Schedule Look-Up

Detailed payment information for specific services covered under the Medicare Physician Fee Schedule can be attained by using the Physician Fee Schedule Look-Up tool in the “Related Links” section below.    

Physician Center
For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) physicians, go to the Physician Center (see under "Related Links Inside CMS" below).