CMS provides carriers with fee schedule relative value units (RVUs) via the Medicare Physicians’ Fee Schedule (MPFS) database for all services except those with local codes, those with national codes for which national relative values have not been established, and those codes listed as not otherwise classified (NOC). For these services, where fees are not available within the MPFS database, MACs may establish local relative values (to be multiplied, in the carrier system, by the national conversion factor), as appropriate, or establish a flat local payment amount. Additionally, on a quarterly basis CMS supplies the contractor with an Average Sales Price (ASP) file for drug pricing. Drugs and biologicals not listed on the quarterly ASP files are the responsibility of the contractor to price based on a percentage of the wholesale acquisition cost as reflected in published resources (e.g., Redbook, etc.). Our local contractor pricing committee, consisting of clinical staff and contractor medical directors, develop fees and drug pricing based on the CMS IOM guidelines. 

Note: The absence or presence of a HCPCS code and/or the payment allowance limits does NOT indicate Medicare coverage of the service or drug. These determinations are made by the local Medicare contractor. There is no published list of contractor priced codes.

Use the related links on the left to learn more about local contractor pricing. 

View contractor priced fees