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Last Modified: 4/2/2024 Location: FL, PR, USVI Business: Part A, Part B

Fees for specific services -- Part A

Where can I find:
• Fees for acute inpatient services
• Fees for ambulance services
• Fees for clinical laboratory services
• Fees for durable medical equipment, prosthetics, orthotics, and supplies
• Fees for end-stage renal disease (ESRD) services
• Fees for hospital outpatient services
• Fees for injectable drugs
• Fees for inpatient psychiatric facility services
• Fees for inpatient rehabilitation facility services
• Fees for mental health services
• Fees for long-term care hospital services
• Fees for outpatient rehabilitation services
• Fees for skilled nursing facility (SNF) services
• Information about the Web Pricer (continuation of the PC Pricer)
Q. Fees for acute inpatient services
A. Acute inpatient services are reimbursed using the acute inpatient prospective payment system (PPS). The acute inpatient PPS Pricer and additional information may be found on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index external link.
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Q. Fees for ambulance services
A. Fees for ambulance services may be found in First Coast’s fee schedule lookup. Additional information may be found here, and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/index external link.
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Q. Fees for clinical laboratory services
A. Fees for clinical laboratory services may be found in First Coast’s fee schedule lookup and under fee schedule data files for compressed, tab-delimited files. Additional information may be found here, and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/index external link.
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Q. Fees for durable medical equipment, prosthetics, orthotics, and supplies
A. Fees for local and joint jurisdiction durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) may be found in First Coast’s fee schedule lookup and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule external link.
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Q. Fees for end-stage renal disease (ESRD) services
A. ESRD services are reimbursed using the ESRD prospective payment system (PPS). The ESRD PPS Pricer and additional information may be found here and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/index external link.
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Q. Fees for hospital outpatient services
A. Hospital outpatient services are reimbursed using the hospital outpatient prospective payment system (PPS). The hospital outpatient PPS Pricer and additional information may be found here and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index external link.
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Q. Fees for injectable drugs
A. Fees for injectable drugs paid under the average sales price (ASP) methodology (for Part A as well as Part B) may be found in First Coast’s fee schedule lookup. Additional information may be found on the CMS website at: https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price external link.
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Q. Fees for inpatient psychiatric facility services
A. Inpatient psychiatric facility services are reimbursed using the inpatient psychiatric facility prospective payment system (PPS). The inpatient psychiatric facility PPS Pricer and additional information may be found on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientPsychFacilPPS/index external link.
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Q. Fees for inpatient rehabilitation facility services
A. Inpatient rehabilitation facility services are reimbursed using the inpatient rehabilitation facility (IRF) prospective payment system (PPS). The IRF PPS Pricer and additional information may be found here and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/index external link.
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Q. Fees for mental health services
A. Fees for mental health services are processed from the Medicare Physician Fee Schedule (MPFS) and may be found in First Coast’s fee schedule lookup under MPFS in the dropdown. Additional information may be found here for Part A or here for Part B, and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index external link
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Q. Fees for long-term care hospital services
A. Long-term care hospital services are reimbursed using the long-term care hospital (LTCH) prospective payment system (PPS). The LTCH PPS Pricer and additional information may be found on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index external link.
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Q. Fees for outpatient rehabilitation services
A. Fees for Part A rehabilitation services may be found in First Coast’s fee schedule lookup under outpatient rehabilitation in the dropdown.
Fees for Part B rehabilitation services paid under the Physician Fee Schedule (MPFS) may be found in First Coast’s fee schedule lookup under MPFS in the dropdown.
Additional information may be found here for Part A or here for Part B, and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index external link
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Q. Fees for skilled nursing facility (SNF) services
A. SNF services are reimbursed using the skilled nursing facility (SNF) prospective payment system (PPS). The SNF PPS Pricer and additional information may be found here and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/index external link.
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Q. Information about the Web Pricer (continuation of the PC Pricer)
A: The payment amount the Web Pricer returns is an estimation of the final prospective payment system (PPS) payment. The Web Pricer cannot be used to validate PPS payment amounts. The final payment may not be precise to how payments are determined in the Medicare claims processing system because other data is factored in the Web Pricer payment amount that is paid by Medicare via provider cost reports. A variance between actual Medicare payment and a Web Pricer estimate may exist as there is typically a three-month lag in quarterly updates to provider data.
Source: Web Pricer external link
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.