Medicare Fee Calculator *

Using AMA's 2010 CPT® codes and CMS' 2010 Physician Fee Schedule, the Healthcare Economic Services (HES) department has developed this tool to assist you in calculating Medicare fees for physicians in the private sector. Because the rates vary by geography, the fee calculator can be used to determine the varying levels of reimbursement when a physician is considering relocation. Many other factors are involved in practice location, organizational affiliation, and provider panel participation. However, the fee calculator can provide useful comparisons when physicians need to know prevailing rates within a region.

Medicare provides care for a great number of people and as such is the primary purchaser of health care services. The rates for Medicare are set annually and commercial payer organizations review these published rates when determining what level of reimbursement they will pay providers. Depending upon the degree of managed care penetration, physicians often see payer rates set at some percentage higher than the Medicare rates. Therefore, it can be very beneficial for physicians to review the most current reimbursement levels for each CPT® listing when determining the fee schedule to be used in their practices or when evaluating managed care contract proposals.

Please refer to the overview to better understand CPT® reimbursement.

To use the calculator, select the geographic area you wish to review. You can enter as many as ten CPT® codes. For comparative purposes, you may also elect to input your fee schedule. The CPT® codes available in this calculator include those codes most frequently used for the care of spine patients to include evaluation and management, spine, cranial, injection procedures, and diagnostic procedures. The Medicare allowance will calculate based on the 2010 published RVUs and a conversion factor of $36.0666.

For additional information or assistance, feel free to email Healthcare Economic Services.

There may be slight variations due to rounding.