Forum - Questions & Answers
establishing charges for codes
Are there specific rules regarding how an office determines the amount they will charge for codes? Specifically, we are trying to determine a dollar amount for the new pulmonary codes for this year. And I guess I am most concerned about Medicare rules.
re: establishing charges for codes
You can get the current RBRVS file at CMS, insert the GPCI(s) for your area and conversion factor, and you will have the current Medicare rate for your area. If it is a small # of codes, your Medicare MAC should have a fee schedule calculator on their web site. Then choose your % mark up to cover your best commercial payer's rates.