New Standard Report - CMS Medicare Fee Schedules

Released 2024.10.30

This new standard report provides users with access to the ReportsAnalysis the ability to view and export current and prior year Medicare fee schedules.

CMS Medicare Fee Schedules Report

This report can be accessed within the Analysis green reporting tile.

Each fee schedule can be searched within the standard GoRev reporting grid and exported to CSV or Excel. Current and Prior year fee schedules are automatically maintained and made accessible via these reports for GoRev clients.

Fee Schedule Details

Below are some additional details as to what each fee schedule represents and where the data originally comes from

RVU (Relative Value Unit):

A measure used in the Medicare fee schedule to assign value to medical services, based on the resources required to provide them. It accounts for physician work, practice expenses, and liability insurance.

Data found here: https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files

APC (Ambulatory Payment Classification):

A system used for outpatient services under Medicare, where procedures are grouped based on clinical and cost similarities. Each APC group has a fixed reimbursement rate.

Data found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates

ASP (Average Sales Price):

The benchmark price for reimbursing drugs under Medicare Part B, calculated based on the manufacturer's sales to all purchasers (excluding certain government sales) and factoring in discounts and rebates.

Data found here: https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files

LAB (Laboratory Fee Schedule):

The payment system for clinical diagnostic laboratory services under Medicare. It establishes the reimbursement rates for lab tests performed in physician offices, hospitals, and independent labs.

Data found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Clinical-Laboratory-Fee-Schedule-Files

ASC (Ambulatory Surgical Center):

A facility offering surgical procedures that do not require an overnight hospital stay. Medicare reimburses ASCs based on a specific fee schedule distinct from hospital outpatient departments.

Data found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

DRG (Diagnosis-Related Group):

A system that classifies hospital inpatient cases into groups expected to have similar hospital resource use. Medicare reimburses hospitals a set fee for each DRG, adjusted for patient severity and regional factors.

Data found here: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page

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