What is the Medicare Physician Fee Schedule?

The Medicare Physician Fee Schedule is the system Medicare uses to determine reimbursement rates for services provided by physicians and other healthcare professionals. It assigns relative value units (RVUs) to procedures based on the resources required to provide them, adjusts for geographic differences in practice costs, and applies a conversion factor to calculate payment amounts.

Why is the Medicare Physician Fee Schedule important?

• Payment standardization: Creates consistent reimbursement for similar services nationwide.
• Resource allocation: Reflects the relative work, practice expense, and liability costs.
• Access influence: Affects which services providers offer and accept Medicare payment for.

Key components of the Medicare Physician Fee Schedule

• Relative Value Units based on physician work, practice expenses, and malpractice insurance.
• Geographic Practice Cost Indices adjusting for regional differences.
• Annual updates and adjustments to reflect changes in healthcare delivery.

How Solace can help‍

A Solace advocate can help you understand how the Medicare Physician Fee Schedule affects your out-of-pocket costs for covered services, identify providers who accept Medicare's approved payment amounts, and assist with appealing coverage determinations when Medicare denies payment for services you need. They can also help you evaluate how fee schedule changes might affect your access to specific services or providers.