This MDTool allows healthcare professionals (physicians, practice administrators, reimbursement and billing professionals and office managers)
to evaluate the aggregate dollar impact on a medical practice of reimbursement changes in the Medicare Physician Fee Schedule between 2021 and any one of the previous years: 2002-2020.
Enter up to 25 CPT® codes and your recent utilization, and the impact analysis will show the increase or decrease in Medicare reimbursement rates between 2021
and the prior year chosen and the change in aggregate reimbursement for each CPT code. (
Note: you can copy and paste the results into a spreadsheet for additional analysis.)
This tool is updated quarterly and annually to reflect Medicare's current fees.
Instruction: To use Impact Analysis tool, you will need your practice's historic procedure volume for the CPT codes you wish to analyze. We recommend that you generate a procedure productivity report by provider or practice for a specific date range from your practice management system. To begin, enter the information requested below. Your zip code is required to return information specific to your locality.
Medicare Fee Schedule Impact Analysis
Please enter the your zip code and other information below for Medicare fee schedule information. Your zip code is necessary to find the CMS carrier, locality and fee.
References 1. CPT - Current Procedural Terminology codes copyrighted by American Medical Association.
2. Par Fee - The fee allowed by Medicare for services provided by participating physicians.
A participating physician agrees to accept Medicare's allowable as the full fee for the service provided.
Medicare pays 80% of the allowed fee to the physician.
3. Non Par Fee - The fee allowed by Medicare for services provided by non-participating physicians.
This fee is 95% of the Medicare Par Fee. Medicare pays 80% of the Non-Par allowed fee to the patient or
the physician depending on whether the non participating physician accepts assignment on the claim.
4. Limiting Charge - The maximum amount that a non participating physician can charge a Medicare beneficiary.
This amount is 115% of the Non Par Fee.
CPT is a registered trademark of the American Medical Association. CPT copyright 2019 American Medical Association. All rights reserved.