How Does The Medicare Fee Schedule Vary?



The Medicare Fee Schedule is very much determined according to costs of renting office space, payroll costs for medical personnel, durable equipment costs, and other factors. The cost of these things will differ from one geographic location to another, making it necessary for the CMS to adjust the Medicare Fee Schedule annually, in no small part in accordance with the cost of doing business in each part of the country.

How This Affects Patients

Depending on where a patient receives treatment and the location of his or her insurance coverage plan, the fees covered by Medicare will be higher or lower, which should cause a patient to want to consider how much health insurance coverage to take out to cover these higher expenses. The Medicare Fee Schedule for each area of the country is updated annually, and this information is available online or from the patient’s Medicare provider. Preexisting conditions, unforeseen accidents, and other medical needs will need to be addressed, making it necessary to have the proper amount of coverage in order to make up for whatever Medicare does not pay.

How Payment Limits Work

Because of the variables in the Medicare Fee Schedule, Medicare sets payment limits for all medical treatment received by the patient, from the ambulance to the emergency room and the equipment used to treat the patient. Unexpected medical needs are covered only up to a certain point because of these payment limits. Each type of treatment, and the amount covered by Medicare, are outlined in the Healthcare Common Procedure Coding System. Physicians and other medical personnel go by this code to receive reimbursement for their services under Medicare.

Why a Medicare Fee Schedule is Necessary

As most people know, the cost of living along with the cost of doing business varies according to local economic climates. For the Medicare system to work effectively and fairly, it is necessary for the HCPCS, the Healthcare Common Procedure Coding System, to allow for these differences in the cost for different medical providers around the country. Medical care in a region of the Midwest may differ in cost only a little bit from the care received in a Southern region, or the cost may differ a lot, depending on the location.



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