Medicare Fee Schedules

The way Medicare fees are established is extremely complex. To determine the reimbursement amount for each procedure (or CPT code), a conversion factor is multiplied by the relative value units (RVUs) that have been assigned to that procedure, and then an adjustment is made based on the geographic location of the practice. The number of RVUs assigned to a procedure is based on three elements: the work required for the procedure, the practice expense incurred for the procedure, and the cost of the provider's professional liability insurance.

2014 Medicare Physician Fee Schedule

CMS has released the valuations of the codes in the 2014 Medicare Physician Fee Schedule. President Obama signed legislation at the end of December which allows for a 0.5% increase in fees through March 31, 2014.  This action averted the implementation of a double-digit cut in fees required by the Sustainable Growth Rate formula (SGR). Major efforts are underway to eliminate the SGR altogether and have Medicare fees more dependent on quality rather than quantity. When the 2014 fees are available they will be posted on the websites of the Medicare Administrative Contractors. Read more...

To find current Medicare fees go to the site of your Medicare contractor.

Members may contact the APA's Practice Management HelpLine by phone 800.343.4671 or email with questions.

NOTE:  All  psychiatry services provided to Medicare patients as of January 1, 2014, will be reimbursed at 80%, just as all other medical services are.