Medicare Physician Fee Schedule

CMS page that explains how to use the CMS Medicare Physician Fee Schedule (MPFS)..

For dates of service in 2023 and 2024, providers will need to submit an invoice when submitting claims for G0465, Autologous platelet rich plasma (PRP), other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment).

A revised file was received for the January 2025 MPFSDB. The Physician Fee Schedule Tool has been updated with these revisions.

The 2025 fees for 0598T Fluorescence wound imaging for bacteria, first anatomic site and 0599T Fluorescence wound imaging for bacteria, each additional anatomic site are detailed in this article.

Palmetto GBA recently completed a fee review for Fluorescence wound imaging for bacteria, first anatomic site and Fluorescence wound imaging for bacteria, each additional anatomic site.

Palmetto GBA has completed a fee review for the Insertion of stent to shunt arterial blood to deep vein of lower leg via catheter using imaging guidance code.

Palmetto GBA has completed an Incontinence Therapy for Men Post-Prostatectomy fee review for Facility and Non-Facility. The codes and 2024 fees are included in this article.

We  price some CPT and HCPCS codes using invoices. Please note that failure to submit an invoice, submitting unclear invoices or submitting incomplete invoices could result in claim rejections.

On November 1, 2022, CMS issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. In the coming days and months, CMS will provide Medicare Administrative Contractors (MACs) with directives including details, instructions and effective and implementation dates on each change outlined in the document. As those details are made available, Palmetto GBA will share that information through our website and listserv messaging.

High energy shock wave therapy for initial wound of outer body surface will be priced at $200.00 effective January 1, 2021.