Search results for "fee schedule"
Enter a HCPCS code, an MS-DRG number, an HCC category, an NCD or LCD number, a denial code (CO-16, N130), a modifier (modifier 25) or a keyword. An exact code opens its page directly; anything else is matched against the tools, the CMS reference, the glossary, product pages, payer guides and articles. Do not enter patient details.
Tools and reference pages
Denial codes (CARC and RARC)
- Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.CARC 45
- Multiple physicians/assistants are not covered in this case.CARC 54
- Processed based on multiple or concurrent procedure rules.CARC 59
- This procedure or procedure/modifier combination is not compatible with another procedure/procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers' compensation state regulations/fee schedule requirements.CARC 236
- Provider contracted/negotiated rate expired or not on file.CARC 147
- Charges exceed our fee schedule or maximum allowable amount.CARC 42
- Payment is adjusted when performed/billed by a provider of this specialty.CARC 172
- Processed under Medicaid ACA Enhanced Fee Schedule.CARC 260
HCPCS Level II codes (supplies, DME, services)
Medicare manual chapters
- Fee Schedule Administration and Coding RequirementsIOM 100-04 ch. 23
Glossary
- Fee-for-ServiceFFS
- Fee SchedulePayer Fee Schedule
- Medicare Physician Fee Schedule (MPFS)MPFS