Use a CMS Medicare fee schedule to automatically keep providers’ favorited Medicare procedure code fees accurate and up to date. When a new fee schedule is added or updated, the latest reimbursement rates are applied within Fee Schedules, reducing manual effort and ensuring consistency across provider-selected codes.
Fee Schedules play a critical role in maintaining standardized rates, improving billing accuracy, supporting timely reimbursements, ensuring regulatory compliance, promoting transparency, and enhancing overall operational efficiency.
Create a CMS Medicare fee schedule
Click Utilities.
Click Practice Setup then Fee Schedules.
Click New Fee Schedule.
Enter a name for the fee schedule in the Name field to clearly identify it. If needed, add additional details in the Description field to provide context, such as the purpose of the fee schedule or the payer it applies to.
Click Select Fee Schedule.
Select the appropriate fee schedule from the Fee Schedule drop-down menu.
Select the appropriate state from the State drop-down menu. This selection helps filter and display the correct Medicare fee schedule localities based on the chosen state, ensuring that the applicable regional rates and guidelines are shown.
Select the appropriate locality from the Locality drop-down menu. The available options will vary based on the state selected. For example, if Maryland is selected as the state, the locality list will update to show only the Medicare fee schedule localities applicable to Maryland, allowing you to choose the correct regional setting.
To multiply the current fee amounts, enter a value in the Fee Amount Multiplier field. For example, if the current fee is $75 and a multiplier of 2 is applied, the updated fee amount will be $150.00.
Click on the Import button.
The fee schedule will be displayed for review. Click Save to confirm and apply the changes. A Saved Successfully notification will then appear to confirm that your updates have been recorded.
The newly created fee schedule will appear in the list of available fee schedules.
Update CMS Medicare fee schedule
Click Utilities.
Click Practice Setup then Fee Schedules.
Click the name of the fee schedule you want to update.
This screen displays all procedure codes along with their associated fee amounts and expected rates if applicable that have been saved within the selected fee schedule.
Click on the Update link.
A confirmation popup will appear to notify you that you are about to update a fee schedule amount. Click Yes to proceed with the update.
Select the appropriate fee schedule from the Fee Schedule drop-down menu.
Select the appropriate state from the State drop-down menu. This selection helps filter and display the correct Medicare fee schedule localities based on the chosen state, ensuring that the applicable regional rates and guidelines are shown.
Select the appropriate locality from the Locality drop-down menu. The available options will vary based on the state selected. For example, if the District of Columbia is selected as the state, the locality list will update to show only the Medicare fee schedule localities applicable to Maryland, allowing you to choose the correct regional setting.
To multiply the current fee amounts, enter a value in the Fee Amount Multiplier field. For example, if the current fee is $75 and a multiplier of 2 is applied, the updated fee amount will be $150.00.
Click on the Import button.
The updated fee schedule will be displayed for review. Click Save to confirm and apply the changes. A Saved Successfully notification will then appear to confirm that your updates have been recorded.
When you return to the updated fee schedule screen, you will see a Last Updated date and timestamp indicating when the fee schedule was most recently modified, including the exact time of the update.
Non-Medicare procedure codes
Updates cannot be made for non-Medicare procedure codes. If you attempt to update these, a notification will appear stating: “There are no favorited procedure codes that can be matched and updated from the CMS fee schedule.”
Click Close to dismiss the notification, or click Cancel to exit the Fee Schedule screen without making changes.
Edit fee amounts
Editing fee amounts allows you to update the dollar values assigned to procedure codes within a fee schedule. This function helps ensure pricing remains accurate and up to date by letting you adjust individual fees or apply changes across multiple codes as needed. Once edits are saved, the updated amounts are immediately reflected in the fee schedule for billing and reporting purposes.
Within the Fee Schedule screen, click inside the Fee Amount field for the CPT code(s) you want to edit, then update the fee amount as needed.
If applicable, click inside the Expected Rate field to adjust the rate as needed.
Click Save to apply and store the updated changes.
Delete fee amounts
Deleting procedure codes from a fee schedule is typically done to keep the schedule accurate, compliant, and up to date with current billing practices. Codes may be removed when they are obsolete, no longer reimbursable, replaced by updated codes, or not relevant to the services provided.
To delete a procedure code from the Fee Schedule screen, locate the code you want to remove and click the red “X” on the far right side of that row. After deleting the code, click Save to apply and store your changes.
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