Medicare Fee Schedule Look-up Directions

These instructions are intended to assist physicians in using the Medicare Physician Fee Schedule Look-up. This tool allows physicians to access fee schedule information from the CMS web site. Information included in these records are fee schedule amounts, RVU's, payment policy indicators and GPCI's.

1. Visit: http://www.cms.hhs.gov/apps/pfslookup/step0.asp

At the top of the page will be a notice that advises you about the AMA copyright of CPT and that you must agree to the licensing agreement if you are going to download the information. If you intend to distribute the CPT information in any manner other than for your practice and educational needs, you should follow the link to the copyright notice, read and accept it. Otherwise, you may scroll to the bottom of the page to start your search.

2. Select “start” (bottom middle of page).

3a. Select the year for which you want information. (If you are looking at a claim for the prior year be sure to select that year.)

3b. Select Healthcare Common Procedure Code(HCPCS).

Single HCPCS code search (any CPT/HCPCS code)

List of HCPCS codes (Search up to 5 CPT/HCPCS codes)

Range of HCPCS Codes (Search any range of CPT/HCPCS codes, for example: 99212-99215)

3c. Type of Information

Pricing Information - This will provide you with the allowable, geographical practice cost index, status, relative value units, global days and conversion factor information.

Payment Policy Indicators- This will provide you with status, professional/technical component and physician supervision indicators.

Relative Value Units - This will provide you with status, professional/technical indicators and work and practice expense relative value units.

Geographical Practice Cost Index(GPCI) - This will provide you with information on the work, practice expense and malpractice expense GPCI numbers.

3d. Choose next.

4a. Select a carrier option if you are searching by pricing information or geographical practice cost index. (If you searched by payment policy indicators or relative value units, this already defaulted for you.)

Nation - gives you the information on your code choice(s) for the nation

Carrier - allows you to search for only information on your code choice(s) by carrier number

Locality - allows you to search for only information on your code choice(s) by the state or area of your carrier

4b. Select a field option if you are searching by pricing information. (If you are searching by payment policy information, relative values or GPCI, this is a default)

All fields - will give you policy and pricing information.

Default fields - will give you pricing information only.

4c. Choose next.

5. Please enter HCPCS and modifier values. If you previously chose to search for geographic cost index, you will have a default here.

HCPCS - here you may have opportunity to enter a single CPT/HCPCS code, range of CPT/HCPCS codes or up to five CPT/HCPCS codes depending on your previous selections.

Modifier - You must select a modifier; usually this will be all or global for family medicine purposes. Other options are professional/technical component modifiers and modifier -53 which represents a procedure which was not completed.

Choose submit unless you wish to change your selections. To change your selections, choose back.

Submitting will take you to page with results matching your criteria.