How to pull the physician fee schedule from CMS.gov website

1. Open the below link in the browser, read the disclaimers then click on "Accept".

Link: https://www.cms.gov/medicare/physician-fee-schedule/search

2. You will get the below screen,

3. Fill in all the fields,

• Year: Select the year for which fee schedule you are looking for,

• Type of Information: There are 4 options available in the drop-down, you can the one that you are looking for or you can select "ALL".

• HCPCS Criteria: There are 3 options available in the drop-down to enter a single CPT, a list of CPT codes, or a range of CPT codes.

• Modifier: Select the modifier as per the requirement,

• MAC Option: It is necessary to know the MAC & Locality to get the correct amount.

• Download the PDF from the below link to know the MAC & Locality numbers,

      Link: https://www.cms.gov/files/document/cy2020-locality-key.pdf

• To know the correct MAC & Locality number from PDF, it is necessary to have the service location address. You can get this address in box number 32 on the CMS 1500 form.

• Match the state available in the service location address with the "state" column of the PDF & city of service location address with the "Fee Schedule Area" column of the PDF.

• The line that matches with both state & city will provide the MAC & the Locality number.

• For example, I am checking the MAC & Locality number for the city & state - Houston, Texas. As per the PDF, it gives the MAC number as "04412" & Locality number as "18".

• Based on it put the correct values in the "MAC Option" and pull the fee schedule.

• Or else select "All MACs" in the MAC Option & download the fee schedule in CSV format then select the correct MAC & Locality number that will provide the same result with the price of the CPT codes.