{"id":14852,"date":"2022-01-06T21:44:49","date_gmt":"2022-01-06T21:44:49","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=14852"},"modified":"2025-07-18T10:07:28","modified_gmt":"2025-07-18T10:07:28","slug":"what-is-mpfs-medicare-physician-fee-schedule","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-mpfs-medicare-physician-fee-schedule\/","title":{"rendered":"What is MPFS (Medicare Physician Fee Schedule)?"},"content":{"rendered":"<h2><span style=\"font-weight: 400;\">Basics of Medicare Physician Fee Schedule<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As the name suggests Medicare Physician Fee Schedule (MPFS) is a complete listing of fees used by Medicare to pay doctors or other providers\/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and\/or other providers on a fee-for-service basis. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare Part B pays for physician services based on the Medicare PFS, which lists the more than 10,000 unique codes and their payment rates. Physicians\u2019 services include office visits; surgical procedures; anesthesia services; and a range of other diagnostic and therapeutic services. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">CMS develops fee schedules for physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries\u2019 homes. Medicare uses the MPFS when paying the following services:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Professional services of physicians and other enrolled health care professionals in private practice;\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Services covered incident to physicians\u2019 services (other than certain drugs covered as incident to services);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diagnostic tests (other than clinical laboratory tests);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiology services.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Medicare also pays suppliers like Mammography Centers according to the MPFS. Medicare pays Institutional providers like hospitals, Comprehensive Outpatient Rehabilitation Facilities (CORFs), and Skilled Nursing Facilities (SNFs) for some services under the MPFS, depending on the institution type and service. <\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>For example<\/strong>, Medicare pays hospital outpatient departments for screening mammographies, and outpatient rehabilitation services, under the MPFS. The MPFS is an excellent way to learn if HCPCS codes are affected by payment policies like payment of assistant at surgery services; applicability of certain modifiers; and physician supervision of diagnostic services.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Medicare Physician Fee Schedule Payment Rates\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The MPFS payment rates formula shows how a payment rate for an individual service is determined, there\u2019s a description for each component below the formula.<\/span><\/p>\n<p><strong>Payment = ( (Work RVU*Work GPCI) + (PE RVU*PE GPCI) + (MP RVU*MP GPCI) ) * CF<\/strong><\/p>\n<h3><span style=\"font-weight: 400;\">Relative Value Units (RVUs): The MPFS uses 3 separate RVUs to calculate a payment:\u00a0<\/span><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Work RVU reflects the relative time and intensity associated with furnishing a Medicare PFS service\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Practice Expense (PE) RVU reflects the costs of maintaining a practice (such as renting office space, buying supplies and equipment, and staff costs)\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Malpractice (MP) RVU reflects the costs of malpractice insurance<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\"><strong>Geographic Practice Cost Indices (GPCIs):<\/strong> Medicare adjusts each of the 3 RVUs to account for geographic variations in the costs of practicing medicine in different areas of the country. Each kind of RVU component has a corresponding GPCI adjustment.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>Conversion Factor (CF):<\/strong> To determine the payment rate for a service, CMS systems multiply the sum of the geographically adjusted RVUs by a CF in dollars. The statute specifies the formula by which the CF is updated on an annual basis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare uses a fee schedule (a complete listing of fees) to pay doctors or other providers and suppliers to pay physicians, other enrolled healthcare professionals or providers and suppliers on a Fee-For-Service (FFS) basis. Medicare bases payment on whichever is less, the charge or MPFS amount. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition to the MPFS, CMS develops fee schedules for ambulance services, clinical laboratory services, and <a href=\"https:\/\/www.medicalbillersandcoders.com\/dme-billing-services-blog\/advantages-of-outsourcing-dme-billing\/\">Durable Medical Equipment<\/a>, Prosthetics, Orthotics, and Supplies (DMEPOS). For most codes, Medicare pays 80 percent of the amount listed and the beneficiary is responsible for 20 percent.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">MPFS Look-Up Tool<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\"><span style=\"font-weight: 400;\">MPFS Look-Up Tool<\/span><\/a><span style=\"font-weight: 400;\"> helps healthcare professionals, suppliers, and institutional providers find Medicare payment amounts for each code so they can calculate the beneficiary coinsurance amount. The MPFS gives a limiting charge for nonparticipating healthcare professionals and suppliers who treat Medicare beneficiaries. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">CMS updates the MPFS quarterly. CMS issued the <\/span><a href=\"https:\/\/www.cms.gov\/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices\/cms-1751-f\"><span style=\"font-weight: 400;\">CY 2022 Medicare Physician Fee Schedule (PFS) final rule<\/span><\/a><span style=\"font-weight: 400;\"> that updates payment policies, payment rates, and other provisions for services.<\/span><\/p>\n<h2>FAQs:<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1752833145573\"><strong class=\"schema-faq-question\">1: What is the Medicare Physician Fee Schedule (MPFS)?<\/strong> <p class=\"schema-faq-answer\">The MPFS is a comprehensive listing of fees that Medicare uses to reimburse healthcare providers on a fee-for-service basis for various services, including office visits and surgical procedures.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752833158606\"><strong class=\"schema-faq-question\">2: How does Medicare determine payment rates under the MPFS?<\/strong> <p class=\"schema-faq-answer\">Payment rates are calculated using a formula that includes Relative Value Units (RVUs) for work, practice expenses, and malpractice, adjusted by geographic cost indices and a conversion factor.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752833169220\"><strong class=\"schema-faq-question\">3: What types of services are covered under the MPFS?<\/strong> <p class=\"schema-faq-answer\">The MPFS covers a wide range of services, including professional physician services, diagnostic tests, radiology services, and certain outpatient services in hospitals and rehabilitation facilities.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752833213159\"><strong class=\"schema-faq-question\">4: How does the MPFS impact non-participating providers?<\/strong> <p class=\"schema-faq-answer\">The MPFS provides a limiting charge for non-participating healthcare providers treating Medicare beneficiaries, which helps determine the maximum amount they can bill for services.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1752833225224\"><strong class=\"schema-faq-question\">5: How often is the MPFS updated?<\/strong> <p class=\"schema-faq-answer\">The MPFS is updated quarterly by the Centers for Medicare &amp; Medicaid Services (<a href=\"https:\/\/cms.gov\/\">CMS<\/a>), which also releases annual updates that include changes to payment policies and rates.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Basics of Medicare Physician Fee Schedule As the name suggests Medicare Physician Fee Schedule (MPFS) is a complete listing of fees used by Medicare to pay doctors or other providers\/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and\/or other providers on a fee-for-service basis. Medicare Part B pays for physician [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":14853,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[3113,51,3114,778,908,81,2285,806,2054,3115,3116,3117,3118,381],"class_list":["post-14852","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue-cycle-management","tag-and-supplies","tag-cms","tag-comprehensive-outpatient-rehabilitation-facilities","tag-dmepos","tag-durable-medical-equipment","tag-hcpcs-codes","tag-medicare-beneficiaries","tag-medicare-part-b","tag-medicare-physician-fee-schedule","tag-mpfs","tag-orthotics","tag-physician-services","tag-prosthetics","tag-skilled-nursing-facilities"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.5 (Yoast SEO v25.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\r\n<title>What is Medicare Physician Fee 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