How to create a Medicare reference fee schedule (part 3)

Medicare provides public reference fee schedules for medical services, laboratory and radiology services, DME, and drugs and injectibles. Making your own Medicare fee schedule provides a ready reference for your practice payments.

Medicare fee schedule part 3: Durable Medical Equipment fee schedule

Go to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html.

Select a time period. The latest data will have the most recent year and highest letter. In this particular case, since DME18-D (orange arrow) links to no updates, we will select DME18-C (green arrow) in this case.

Download the file (e.g. DME18-C.zip).

In the zip file, open the DMEPOS file (e.g. DMEPOS_JUL.xls)

The relevant columns in this file are the HCPCS code column (column A), the HCPCS code description column (column DJ), and the appropriate state column for your state.

Each state has two columns, nonrural (NR) and rural (R). To determine if you're in a rural or nonrural location, look in the DMERuralZip file (e.g. DMERuralZip_Q32018). If your zip code is listed, then use the rural (R) payments as a guide.

Delete all state columns that are irrelevant for your location.

If you are in a rural area, combine the nonrural and rural fee schedules into a single column. If the rural column shows 0.00 (green arrow), the rural payment for that HCPCS is the same as the nonrural payment. If the rural column shows a nonzero value (orange arrow), the higher rural column payment applies to rural areas.

To simply combine the rural/nonrural fees in this way, you can create a formula to take the maximum of the two columns into a third column.

To propagate the formula down to the bottom of the sheet, select the cell with the formula, Ctrl-C to copy it, click on an empty cell, drag down to the bottom, then type Ctrl-V.