Physician Fee Schedule
This site contains informational materials related to the Medicare Physician Fee Schedule.
2005 |2004 |2003 |2002 | 2001 |2000 | 1999 |
2005 Information
2005 Proposed Rule and Supporting Documentation
CMS-1429P was published at the Office of the Federal Register on
August 5, 2004(PDF 56Kb)
- Scaling Factors Used to Adjust Estimated Costs for Individual Procedures (Excel file ZIP 8Kb) To develop practice expense relative value units, estimates of costs for individual procedures are adjusted by "scaling factors" to match them with estimated aggregate costs for each physician specialty obtained from practice expense surveys. The file contains the scaling factors that were used to develop the 2005 proposed rule as well as those that would result from elimination of the non-physician work pool. See August 5, 2004 rule for a more detailed description of this information. New
- Recommendations Regarding Supplemental Practice Expense Data Submitted for 2004 Final Report(PDF 241Kb) Evaluation of Survey Data for: Independent Laboratory. Prepared for: Centers for Medicare and Medicaid Services. Prepared by: Allen Dobson, Ph.D., Lane Koenig, Ph.D., Jonathan Siegel, M.A., The Lewin Group, September 23, 2003.
- Physician Time File Used To Create the Proposed Resource-Based Practice Expense Relative Value Units For Calendar Year 2005 (ZIP 176Kb) This file contains physician or clinical staff times use to create practice expense relative value units for more than 7,000 different procedure codes that will be paid by Medicare using the Medicare Physician Fee Schedule (MPFS) in 2005.
- Specialty Utilization File Used To Create Proposed Resource-Based Practice Expense Relative Value Units For Calendar Year 2005 (ZIP 6.5Mb-Please note file size before downloading.) This file contains Medicare utilization data used to develop the 2005 resource-based practice expense relative value units and the payment impacts displayed in the physician fee schedule proposed rule. The Medicare utilization data used to develop practice expense relative value units is combined data from calendar years 1997 through 2000 for codes that existed during this period. For codes that were first established after 2000, the utilization is from the first year in which the codes were in use. If the procedure code is new in 2004, the information represents an estimate of utilization using a crosswalk from the 2003 utilization. The utilization data used for payment impacts is from 2003. The 2003 utilization reflects claims received through March 31, 2004 and is estimated to be 97.6 percent complete. The data reflects an adjustment to estimate a complete year's utilization.
- Direct Practice Expense Values Used To Create Resource-Based Practice Expense Relative Value Units For Calendar Year 2005(ZIP 2Mb) This file contains resource inputs used in establishing resource-based practice expense values for more than 7,000 physician services. There are 3 different types of practice inputs: clinical staff, medical supplies and medical equipment. The source of the resource inputs are from one of the following: (1) Clinical Practice Expert Panels (CPEPs) convened in 1995 to develop estimates of the different types of resource inputs necessary to perform medical services (2) A crosswalk to a related service developed based upon a clinical opinion by CMS (formerly known as HCFA) (3) the AMA's Relative Value Update Committee (RUC) (4) refinement of the CPEP inputs by the AMA's Practice Expense Advisory Committee (PEAC) (5) CMS 's clinical judgment or (6) A medical specialty society.
- Recommendations Regarding Supplemental Practice Expense Data Submitted for 2005, Final Report (PDF 339Kb) Evaluation of Survey Data for: Cardiology, Radiology, and Radiation Oncology. Prepared for: Centers for Medicare and Medicaid Services. Prepared by: Allen Dobson, Ph.D., Lane Koenig, Ph.D., Jonathan Siegel, M.A., The Lewin Group, May 26, 2004.
2004 Information
2004 Final Rule and Supporting Documentation
CMS-1372-IFC was published at the Office of the Federal Register on
January 7, 2004
CMS-1372-FC Medicare Program; Revisions to Payment for Drugs and Physician Fee Schedule Payments for Calendar Year 2004
- View the Press Release
CMS-1476-FC Final Rule Published 11/07/2003
CMS-1476-FC Display: 10/30/2003
CMS-1476-FC Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004
Supporting Data Files
- Practice Expense Per Hour Information Used to Create Cost Pools (Excel file zipped 3Kb) - To develop practice expense relative value units, Medicare creates aggregate cost pools for each specialty using practice expense per hour information from surveys. The attached file contains the practice expense per hour information that we used to develop the 2004 practice expense RVUs. See January 7, 2004 rules for a more detailed description of this information.
- Scaling Factors Used to Adjust Estimated Costs for Individual Procedures(Zip file 7Kb) (Updated 01/22/04) - To develop practice expense relative value units, estimates of costs for individual procedures are adjusted by "scaling factors" to match them with estimated aggregate costs for each physician specialty obtained from practice expense surveys. The attached file contains the scaling factors that were used to develop the 2004 final rule. See November 7, 2003 and January 7, 2004 rules for a more detailed description of this information.
- 2004 Practice Expense Inputs (Zip File 1533Kb)(Updated 04/26/04) - This file contains resource inputs used in establishing resource-based practice expense values for more than 7,000 physician services. There are 3 different types of practice inputs: clinical staff, medical supplies and medical equipment. The source of the resource inputs are from one of the following: (1) Clinical Practice Expert Panels (CPEPs) convened in 1995 to develop estimates of the different types of resource inputs necessary to perform medical services (2) A crosswalk to a related service developed based upon a clinical opinion by CMS (formerly known as HCFA) (3) the AMA's Relative Value Update Committee (RUC) (4) refinement of the CPEP inputs by the AMA's Practice Expense Advisory Committee (PEAC) (5) CMS 's clinical judgment or (6) A medical specialty society.
- Medicare Utilization (Zip File 8029Kb)(Updated 01/22/04)- This file contains Medicare utilization data used to develop the 2004 resource-based practice expense relative value units and the payment impacts displayed in the physician fee schedule final rule. The Medicare utilization data used to develop practice expense relative value units is combined data from calendar years 1997 through 2000 for codes that existed during this period. For codes that were first established in 2001 or 2002, the utilization is from the first year in which the codes were in use. If the procedure code is new in 2003, the information represents an estimate of utilization using a crosswalk from the 2002 utilization. The utilization data used for payment impacts is from 2002. The 2002 utilization reflects claims received through June 30, 2003 and is estimated to be 98.5 percent complete. The data reflects an adjustment to estimate a complete year's utilization.
- Physician and Clinical Staff Time Used to Create 2004 Practice Expense Relative Value Units (Zip file 166Kb) (Updated 04/26/04). This file includes estimates of physician time associated with procedure codes paid using the physician fee schedule. It also includes estimates of clinical staff time for certain codes that are not performed by physicians. These times estimates were used to create the 2004 practice expense relative value units.
2004 National Physician Fee Schedule Relative Value File
2004 Physician Fee Schedule Payment Amount File National/Carrier
CMS-1476-CN PUB DATE: 09/26/2003
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004; Correction (PDF - 31.5 Kb)
This document corrects an error that appeared in the proposed rule published in the Federal Register on August 15, 2003 entitled "Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004."
2004 Proposed Rule and Supporting Documentation
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004 (CMS-1476-P)
This document went on display at the Office of the Federal Register Friday, August 8, 2003, and was published Friday, August 15, 2003. The comment period will close on October 7, 2003.
Supporting Data Files
- Supplemental Repricing File(Zip file 79Kb)
- 2004 Practice Expense Inputs(Zip File 2406Kb) - This file contains resource inputs used in establishing resource-based practice expense values for more than 7,000 physician services. There are 3 different types of practice inputs: clinical staff, medical supplies and medical equipment. The source of the resource inputs are from one of the following: (1) Clinical Practice Expert Panels (CPEPs) convened in 1995 to develop estimates of the different types of resource inputs necessary to perform medical services (2) A crosswalk to a related service developed based upon a clinical opinion by CMS (formerly known as HCFA) (3) the AMA's Relative Value Update Committee (RUC) (4) refinement of the CPEP inputs by the AMA's Practice Expense Advisory Committee (PEAC) (5) CMS 's clinical judgment or (6) A medical specialty society.
- Medicare Utilization(Zip File 2022Kb) - This file contains Medicare utilization data used to develop the 2004 resource-based practice expense relative value units and the payment impacts displayed in the physician fee schedule final rule. The Medicare utilization data used to develop practice expense relative value units is combined data from calendar years 1997 through 2000 for codes that existed during this period. For codes that were first established in 2001 or 2002, the utilization is from the first year in which the codes were in use. If the procedure code is new in 2003, the information represents an estimate of utilization using a crosswalk from the 2002 utilization. The utilization data used for payment impacts is from 2002. The 2002 utilization reflects claims received through March 31, 2003 and is estimated to be 96 percent complete. The data reflects an adjustment to estimate a complete year's utilization.
- Scaling Factors Used to Adjust Estimated Costs for Individual Procedures(Zip File 18Kb)- To develop practice expense relative value units, estimates of costs for individual procedures are adjusted by "scaling factors" to match them with estimated aggregate costs for each physician specialty obtained from practice expense surveys. The attached file contains the scaling factors that were used to develop the 2004 proposed rule as well as those that would result from elimination of the non-physician work pool. See August 15, 2003 rule for a more detailed description of this information.
- Supporting Data Files
- Practice Expense Input File Used to Create 2003 Practice Expense Relative Value Units (self-extracting zip file 2.9MB). This file contains estimates of clinical staff time, medical supply costs and medical equipment used to determine the calendar year 2003 Medicare Physician Fee Schedule practice expense relative value units. It also includes a table that merges and summarizes practice expense estimates to the procedure code level.
- Physician and Clinical Staff Time Used to Create 2003 Practice Expense Relative Value Units (self-extracting zip file 137Kb). This file includes estimates of physician time associated with procedure codes paid using the physician fee schedule. It also includes estimates of clinical staff time for certain codes that are not performed by physicians. These times estimates were used to create the 2003 practice expense relative value units.
- 1997 - 2001 Procedure Code Utilization By Specialty (self-extracting zip file 3.2MB). This file includes 1997 to 2001 Medicare utilization that was used to develop the 2003 physician fee schedule practice expense RVUs. There is one table that shows the combined 1997 to 2001 Medicare utilization for most specialties that bill Medicare for physician fee schedule services. This table excludes any utilization by mid-level practitioners and selected other physician specialty codes that have little physician fee schedule utilization. For a more detailed explanation of the why the practice expense RVUs were calculated excluding utilization of certain specialty information, see page 44188 of the Notice of Proposed Rulemaking published in the Federal Register on July 17, 2000 and page 40397 of the August 2, 2001 Notice of Proposed Rulemaking. There is a second table that includes 2001 Medicare utilization only for all physician, non-physician practitioners and medical suppliers that billed Medicare for physician fee schedule services. Due to the Privacy Act, the data does not contain services performed less than 10 times by a specialty.
- The zip file contains the following:
- Proposed Rule (cms1204p.doc 288KB in MS Word Format)
- Table 2 -- Impact of Practice Expense Changes on Total Medicare Allowed Charges by Physician, Practitioner and Supplier Subcategory (table2.xls 32KB in MS Excel Format)
- Table 3 -- Estimated Impact Practice Expense and Update on Total Medicare Allowed Charges by Specialty (table3.xls 28KB in MS Excel Format)
- Table 4 -- Impact of Proposed Rule and Physician Fee Schedule Update on Medicare Payment for Selected Procedures (table4.xls 36KB in MS Excel Format)
2003 Information
2003 Medicare Physician Fee Schedule - Final Rule, Q & A Document and Fact Sheet Published 2/28/2003 - Implementing instructions are included in Program Memorandum (PM) AB-03-027 (PDF Format 105kb)- Payment Change for the 2003 Medicare Physician Fee Schedule (MPFS) and Further Extension of the 2003 Participation Enrollment Process. This PM also includes requirements for Physician/Provider education.
Physician Fee Schedule Payment Amount File National/Carrier
National Physician Fee Schedule Relative Value File
Medicare Physician Fee Schedule Final Rule - Published 12/31/2002
Medicare Program; Revisions To Payment Policies Under The Physician Fee Schedule For Calendar Year 2003 And Inclusion Of Registered Nurses In The Personnel Provision Of The Critical Access Hospital Emergency Services Requirement For Frontier Areas And Remote Locations (CMS-1204-FC) - Posted 12/20/2002
Program Memorandum: AB-02-181 (adobe pdf file 135Kb) - Medicare Physician Fee Schedule (MPFS) Update and the 2003 Participation Enrollment Process (December 23, 2002)
Recommendations Regarding Supplemental Practice Expense Data Submitted for 2003 (PDF File 627Kb) - Evaluation of Survey Data for: Physical Therapy, Oncology, Cardiology, and Pediatrics. Prepared For: Centers for Medicare & Medicaid Services. Prepared By: Allen Dobson, Ph.D., Lane Koenig, Ph.D., Jonathan Siegel, M.A., Silver Ho, M.P.P., and Jawaria Gilani, M.P.H., The Lewin Group.
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2003 -- CMS-1204-P (103KB Zip File)
Criteria for Submitting Supplemental Practice Expense Survey Data Under the Physician Fee Schedule -- CMS-1223-IFC (14KB Zip File contains cms1223ifc.doc in MS Word Format)
2002 Information
Validation of Physician Time Data Final Report, Prepared by: Nancy T McCall, Sc.D., Jerry Cromwell, Ph.D., Ed Drozd, Ph.D., Sonja Hoover, M.P.P., Health Economics Research, Inc., December 12, 2001
2002 Physician Fee Schedule Payment Amount File - National/Carrier-Specific
Recommendations Regarding Supplemental Practice Expense Data Submitted for 2002 (zip format 28Kb), Evaluation of Survey Data for: Physical Therapy, Optometry, and Pediatrics, Prepared for Centers for Medicare and Medicaid Services, Prepared by Allen Dobson, Ph.D., Lane Koenig, Ph.D., Jonathan Siegel, M.A., and Silver Ho, M.P.P. (The Lewin Group, Inc.)
2002 Interim Resource-Based Practice Expense Data Files
2002 National Physician Fee Schedule Relative Value File
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2002 (CMS-1169-FC)
Payment Policies Under the Physician Fee Schedule for Calendar Year 2002 (CMS-1169-P)
2001 Information
2001 Interim Resource-Based Practice Expense Data Files
2001 National Physician Fee Schedule Relative Value File
THE RESOURCE-BASED PRACTICE EXPENSE METHODOLOGY: AN ANALYSIS OF SELECTED TOPICS (Adobe PDF (909Kb) or Rich Text) (zipped 57Kb), Prepared for Centers for Medicare and Medicaid Services, Prepared by Allen Dobson, Ph.D., Lane Koening, Ph.D., and Jeanne Cavanaugh (The Lewin Group, Inc.)
Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule
AN EVALUATION OF THE HEALTH CARE FINANCING ADMINISTRATION'S
RESOURCE-BASED PRACTICE EXPENSE METHODOLOGY Final Report -- Adobe PDF (909Kb) or Rich Text (zipped 57Kb)
Prepared for Health Care Financing Administration, Prepared by Allen
Dobson, Ph.D., Lane Koening, Ph.D., Eron Sturm, and Jeanne Cavanaugh
(The Lewin Group, Inc.)
2001 Physician Fee Schedule Payment Amount File - National/Carrier-Specific
Recommendations Regarding Supplemental Practice Expense Data Submitted for 2001 in MS Word (zipped 562Kb) or Adobe PDF Formats (225Kb) (October 10, 2000)
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2001 (HCFA-1120-FC)
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2001 (HCFA-1120-P)
CPEP Recorders' Notes Files - PDF Format 10MB (draft)
Practice expense data files used in creating the 2001 Practive Expense Relative Values
2000 Information
2000 Procedure Code Utilization By Specialty
Validating Patient Care Hours Used in HCFA's Practice Expense Methodology (draft)
2000 Interim Resource-Based Practice Expense Data Files
Practice Expense Methodology Report
Five Year Review of Work Relative Value Units (HER)
Relative Value Update Committee (RUC) Clinical Practice Expert Panel (CPEP) Recommendations (zipped 244Kb) -- The American Medical Association's (AMA) RUC forwarded recommendations on practice expense inputs for 65 CPT codes to HCFA. This self-extracting file contains the practice expense input sheets for these codes.
2000 CPEP Input Files (zipped 5.9MB) -- This zip file contains the recommended CPEP practice expense input files for the calendar year 2000 Medicare Physician Fee Schedule.
Physician Fee Schedule Regulation
2000 Physician Fee Schedule Payment Amount File - National/Carrier-Specific
2000 National Physician Fee Schedule Relative Value File
1999 Information
Summary of Medicare Physician Fee Schedule Database Changes for 1999
1999 Physician Fee Schedule Payment Amount File - National/Carrier-Specific
1999 National Physician Fee Schedule Relative Value File
1999 Anesthesia Conversion Factors
1999 Interim Resource-Based Practice Expense Data Files
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