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 Reimbursement Tools

Centers for Medicare and Medicaid Services Web Tools

The following link will take you to CMS’s National Correct Coding Initiative files:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage

From this page, you can select the file with the CPT code range that you are interested in.  If 26040 is the code we are looking for, you would click on the Surgery: Musculoskeletal System code range, accept the license agreement and then open the zip file.  In the next window, open the Excel file.   You’ll have a number of zip files you can open.  Again, select the range with the code you’re looking for (i.e. 24000-26999).  Once in the zip file, you’ll want to open the Excel  file.  Find the code you are looking for in column A.  All the codes in column B in the range would not be allowed.   
 
Download Medically Unlikely Edits from the NCCI website:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage

Download Medicare drug pricing files:
http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp

AMA Fee Schedule Analysis Guide

The American Medical Association (AMA) Private Sector Advocacy (PSA) Practice Management Center (PMC) has developed a new educational resource: “Fee schedule analysis: Using your complete practice cost as a guide.”

This educational resource was developed to help physicians and their practice staff recognize the need to establish their practice fee schedule based on what it actually costs to provide a service rather than basing their fee schedule on what a third-party payer or other entity decides is fair payment.  This resource includes a 12-step guide to help physician practices create their own unique physician practice fee schedule with an easy-to-complete spreadsheet.

This resource is available to AMA members on the PSA Web site at www.ama-assn.org/go/psa under the Defensible Fee Schedule Toolkit, along with the interactive spreadsheet that allows physicians to create their unique physician practice fee schedule by entering practice specific information.

If you have any questions about this resource, please contact Cindy Penkala at the AMA 312-464-4673.