Fee schedule help and news
Help and references
Differences between fee schedule file types
This article explains the differences between the First Coast Part B fee schedule lookup, PDF files, and zipped text files.
Finding fee schedule policy indicators
How to find policy indicators such as global days for a service, relative value units (RVUs) for a particular code, and more.
Determining the correct locality
This article will help finding the correct locality fee schedule.
Fee schedule par, non-par, and limiting charge explanation
Definitions of par fee, nonpar fee, and limiting charge in the Medicare Physician Fee Schedule.
Florida payment localities by county
Here is a listing of the counties comprising each payment locality in Florida.
Medicare physician fee schedule payment policy indicators
This provides definitions of the national policy indicators for each procedure code (and modifier, where applicable) on the Medicare physician fee schedule database (MPFSDB).
ZIP codes requiring a nine-digit ZIP code (ZIP +4)
To access a file containing the quarterly additions and deletions to the list of ZIP codes requiring a plus four extension, refer to this link to the CMS website.
View this article for information regarding local contractor pricing.
Fee development process of new drug code pricing
View this article for information regarding local contractor pricing.
Federal sequestration payment reductions
Find information pertaining to the 2% reduction in Medicare payments due to sequestration.
News / updates
Medicare Diabetes Prevention Program (MDPP) 2025 changes
Effective January 1, CMS has removed the MDPP bridge payment (HCPCS code G9890) from the 2025 fee schedule and updated the payment rates. Claims will be denied for HCPCS code G9890 for dates of…
Quarterly update to the Medicare Physician Fee Schedule (MPFS) - April 2025
These changes will be implemented April 7, effective for services January 1 and after.
2023 fee schedule updates for HCPCS 96380 and 96381 - Puerto Rico and U.S. Virgin Islands
View pricing for two new codes for administration of nirsevimab for RSV infection.
2023 Fee schedule updates for HCPCS 96380 and 96381: Florida
View pricing for two new codes for administration of nirsevimab for RSV infection.
2023 fee schedule updates for HCPCS 96380 and 96381
View pricing for two new codes for administration of nirsevimab for RSV infection.
Pricing has been updated for codes 93241, 93243, 93245, and 93247.
Pricing has been updated for codes 93241, 93243, 93245, and 93247.
COVID-19: Allowances for laboratory test codes
Allowances are now available for new codes for COVID-19 testing. Codes 0202U, 0223U, 0224U, and 87426 were added effective June 25. Codes 0225U, 0226U, 86408, and 86409 were added effective August 10…
Part B reimbursement fees: Transportation of portable X-ray equipment (R0070/R0075)The 2026 cost analysis survey for HCPCS codes R0070 and R0075 is now available. Surveys must be submitted no later than July 31.
Pre-exposure Prophylaxis (PrEP) using antiretroviral therapy to prevent HIV infection
CMS has issued a final NCD for FDA-approved Pre-exposure Prophylaxis (PrEP) using antiretroviral drugs to prevent HIV infection. Note: Local contractor pricing has been revised for code J0750. Please…