Last Modified: 10/3/2018 Location: FL, PR, USVI Business: Part A, Part B
Differences between fee schedule file types FAQ
Q. Are there differences between the First Coast Part B fee schedule lookup, PDF files, and zipped text files?
A. Yes. Although they are very similar with regards to content, there are notable differences.
• Fee schedule portable document format (PDF) files in the Fee Schedule Data Files section are a “snapshot” of the Medicare physician fee schedule (MPFS) fees upon which providers’ annual participation enrollment decisions are made. Also known as annual disclosure reports, the PDF files are usually updated annually and do not include any quarterly changes.
• Zipped (compressed) text-only files in the Fee Schedule Data Files section are derived from the annual disclosure files, but are formatted as tab-delimited text so the fees may be easily downloaded into a spreadsheet or database, for incorporation into billing software or for other uses. These tab-delimited text-only files are updated each quarter, as necessary.
• The allowances in the fee schedule lookup tool are pulled directly from the Part B processing system, MCS (Multi-carrier system), and are generally updated quarterly. Off-cycle updates to the MCS are included in the lookup responses, however. Additional fees, including those for carrier-priced codes and fees for certain services reimbursed from fee structures other than the MPFS are provided in the lookup tool (e.g., fee information for ambulance services, clinical laboratories, average sales price (ASP) drugs, and more).
• For MPFS services that are capped by the outpatient prospective payment system (OPPS) amount, the PDF and zipped files provide only the capped amounts for you but the lookup application provides both the OPPS and NON-OPPS amounts. When both amounts are present in the lookup tool you should use the lower of the two.
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