Medicare Archives

FAQ-Medicare Fee Schedule

Medicare Fee Schedule FAQs Q: Where can I find my Medicare Fee Schedule? A: You can find the Medicare Fee Schedule on your Medicare Administrative Contractor’s (MACs) website. Many of the MACs offer a link on their home page that directs you to the fee schedule look-up tool. You need to know your enrollment status…

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Additional Rules Options -Excluded Services

Additional Rules and Options for Statutorily Excluded Services The only services covered under Medicare when ordered or delivered by a chiropractor are the three spinal adjustment codes (98940, 98941, 98942). These codes are only covered when Medical Necessity is met; otherwise, the patient is considered in the maintenance phase of care. When a patient transitions…

Medicare Fee Schedule-Non-Par Providers

Review of Medicare Fee Schedule for Non-Participating Providers When a provider chooses to be Non-participating with Medicare, it is not the equivalent of being out of network with other carriers. Unlike the participating provider, a Non-participating provider should only bill Medicare according to the Medicare fee schedule. If actual fees are sent to Medicare, the…

Medicare Fee Schedule-Par Providers

Review of Medicare Fee Schedule for Participating Providers All participating providers must be enrolled with Medicare and must bill Medicare on behalf of the beneficiary for all covered services unless otherwise instructed by the beneficiary. Participating providers may choose to send their actual fee to Medicare or to use the Medicare allowed amount as their…

Do’s and Don’ts for Working with Medicare Charges and Fees

We could all use a visual wake-up call detailing the pitfalls surrounding charges and fees when working with Medicare patients. It is important to be aware of the four inconsistencies in billing that the OIG watches for, the three categories of Medicare fees, and how you can help patients manage their financial responsibilities while staying…

Status Determines Medicare Fee

Participation Status Determines Medicare Fee Schedule When providers initially enroll with Medicare, their level of participation with Medicare is determined. You have the option to change this status during open enrollment periods each year or during your revalidation process. It is imperative that the provider and staff know and understand how the level of participation…