PFS Look-up Tool Overview

What's the PFS Look-Up Tool?

The PFS Look-Up Tool gives Medicare payment information on more than 10,000 services, including:

• Pricing
• Associated relative value units (RVUs)
• Payment policies

The tool doesn’t display Medicare Administrative Contractor (MAC) priced codes or Medicare Part B non-payable codes.

How Does the Tool Work?

The PFS Look-Up Tool helps you find Medicare payment amounts for each code so you can calculate the patient coinsurance amount. The PFS gives the limiting charge for nonparticipating providers and suppliers who treat Medicare patients.

You can use a single procedure code, a range of procedure codes, or a list of procedure codes to search for national payment amounts through a specific MAC or a specific MAC locality.

Why Should I Use This Tool?

Use the PFS to check if these payment polices affect HCPCS codes:

• Payment of assistant at surgery services
• Applicability of certain modifiers
• Physician supervision of diagnostic services

How Do We Adjust the PFS Pricing Amounts?

We adjust the PFS pricing amounts to reflect the variation in practice costs from area to area. Each Medicare payment locality has a geographic practice cost index (GPCI) for the 3 components of a procedure's relative value unit (like the RVUs for work, practice expense, and malpractice). We apply the GPCIs in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component.

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Disclaimer:
This display tool is an aid for physicians and nonpractitioners looking for PFS payment rates. We make no warranties, expressed or implied, regarding errors or omissions and assume no legal liability or responsibility for loss or damage resulting from the use of information in the tool. For the official and definitive CMS PFS payment files, contact your MAC.