2021 Medicare Physician Fee Schedules (MPFS)
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2021 Medicare Physician Fee Schedules (MPFS)
You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): .
The fee schedules below are effective for dates of service January 1, 2021, through December 31, 2021. See below for the following updates:
- Updated pricing for code G2170 and G2171 effective January 1, 2021
- Corrected pricing for codes G2082 & G2083 (April 2021 Updates)
- Updated G9868, G9869, and G9870 effective April 1, 2021
- Updated 0501T-0504T, 0513T, & 0523T effective January 1, 2021
- Updated 0492T (effective May 21, 2021) and 0207T, 0402T, & 0563T (effective July 1, 2021)
- Updated R0070, R0075, and 0598T effective January 1, 2021
- Updated 0483T, 0484T, and 0548T effective July 1, 2021
- Updated 93241, 93243, 93245, and 93247 effective January 1, 2021
- Updated 0642T effective July 1, 2021
- Updated 0650T effective September 23, 2021
Instructions for Downloading Medicare Physician Fee Schedules
Important: You must select J5 MAC Part B to view fee schedule files for Iowa, Kansas, Missouri, and Nebraska. You must select J8 MAC Part B to view fee schedules files for Indiana and Michigan. To change your selection, use the “Click here to change” link at the top of this web page.
Medicare Physician Fee Schedule Localities
A Medicare fee locality is a specific geographical area CMS designates to use for payment. CMS typically divides fee localities along county lines, and they may consist of a single county, several counties or may be a statewide designation.
Medicare uses the MPFS localities to determine payments for codes included on the Medicare Physician Fee Schedule. Please keep in mind that Medicare determines the locality based on the ZIP code of the facility where the provider performs the service, not where the provider’s office is located.
Medicare Physician Fee Schedules Effective January 1, 2021, through June 30, 2021
State/MPFS Locality | County | Excel Files | PDFs |
---|---|---|---|
Iowa | All | Download Excel File | Download PDF |
Kansas | All | Download Excel File | Download PDF |
Missouri Locality 01 | Saint Louis City, Saint Louis, Jefferson, and Saint Charles | Download Excel File | Download PDF |
Missouri Locality 02 | Clay, Jackson, and Platte | Download Excel File | Download PDF |
Missouri Locality 99 | All counties not included in localities 01 and 02 | Download Excel File | Download PDF |
Nebraska | All | Download Excel File | Download PDF |
State/MPFS Locality | County | Excel Files | PDFs |
---|---|---|---|
Indiana | All | Download Excel File | Download PDF |
Michigan Locality 01 | Macomb, Oakland, Washtenaw, and Wayne | Download Excel File | Download PDF |
Michigan Locality 99 | All other counties | Download Excel File | Download PDF |
Medicare Physician Fee Schedules Effective July 1, 2021, through December 31, 2021
State/MPFS Locality | County | Excel Files | PDFs |
---|---|---|---|
Iowa | All | Download Excel File | Download PDF |
Kansas | All | Download Excel File | Download PDF |
Missouri Locality 01 | Saint Louis City, Saint Louis, Jefferson, and Saint Charles | Download Excel File | Download PDF |
Missouri Locality 02 | Clay, Jackson, and Platte | Download Excel File | Download PDF |
Missouri Locality 99 | All counties not included in localities 01 and 02 | Download Excel File | Download PDF |
Nebraska | All | Download Excel File | Download PDF |
State/MPFS Locality | County | Excel Files | PDFs |
---|---|---|---|
Indiana | All | Download Excel File | Download PDF |
Michigan Locality 01 | Macomb, Oakland, Washtenaw, and Wayne | Download Excel File | Download PDF |
Michigan Locality 99 | All other counties | Download Excel File | Download PDF |
Updates to the 2021 Medicare Physicians Fee Schedule
Pricing Update for 0650T
Medicare Physician Fee Schedule (MPFS) Update for Procedure Code 0605T
Pricing Update for 0642T
Medicare Physician Fee Schedule (MPFS) Update for Procedure Code 0642T
Pricing Update for G2170 and G2171
Medicare Physician Fee Schedule (MPFS) Update for Procedure Codes G2170 and G2171
Pricing Update for 0483T, 0484T, 0548T, 93241, 93243, 93245, and 93247
Pricing Update for Codes R0070, R0075, and 0598T
Medicare Physician Fee Schedule (MPFS) Updates for Procedure Codes R0070, R0075, and 0598T
Pricing Update for Codes 0207T, 0402T, 0492T, and 0563T
Medicare Physician Fee Schedule (MPFS) Updates for Procedure Codes 0207T, 0402T, 0492T, & 0563T
October 2021 Updates
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – October 2021 Update MM 12422 .
July 2021 Updates
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 Update MM 12289
Pricing Update for Codes 0501T-0504T, 0513T, and 0523T
Medicare Physician Fee Schedule (MPFS) Updates for Procedure Codes 0501T-0504T, 0513T, and 0523T
April 2021 Updates
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 Update MM 12155
Medicare Physician Fee Schedule (MPFS) Update for April 2021
Column Headings on the Medicare Physician Fee Schedule
Note
If an indicator is present, it signifies a special condition applies to the service. (Indicators are defined at the top of the MPFS.)
Procedure
Procedure code (CPT code or HCPCS code)
Mod
Modifier (Only pricing modifiers 53, 26 and TC are included on the MPFS)
Par Amount
Fee schedule amount for participating providers
Non-Par Amount
Fee schedule amount for non-participating providers
Limiting Charge
Maximum amount the beneficiary may be billed (applies to services on unassigned claims submitted by non-participating providers)
Medicare Physician Fee Schedules Resources
For additional information on procedures, including relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.) you may wish to access the Medicare Physician Fee Schedule Database (MPFSDB)/Relative Value File on the CMS website.
CMS offers the complete file in several different formats and provides a single code look up.
Access the Medicare Physician Fee Schedule Database (MPFSDB)/Relative Value File on the CMS website.
Access the Medicare Physician Fee Schedule Database (MPFSDB)/Fee Schedule Look-Up.
Access the National Physician Fee Schedule Payment Amount File.
global-tags: J8B,Fees and Reimbursement,J5B,Physician Fee Schedule
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