In your account, you enter the Medicare locality for your practice, and SpeedECoder calculates the actual payment that you will receive from Medicare. For laboratory tests and durable medical equipment, the appropriate fees for your locality are displayed. The Medicare Physician Fee Schedule (MPFS), which contains the CPT and HCPCS codes that physicians can bill to the Medicare program through Part B, contains additional billing informationin addition to the fee.
For procedures paid by the MPFS, the Code Detail display shows a host of information. The fees from Medicare can differ when the procedure is performed in a establishment that the treating physician owns or at another third-party owned facility. Both fees are reported in the Code Details page for the procedure along with the -26 (professional component) and -TC (technical component) modifiers.
In addition to the fees, SpeedECoder displays the relative value units (RVUs) that underlie the fee calculations and the flags that determine the final billing rules for the code. The first flag is the status code that indicates whether the code is in the fee schedule and whether it is separately payable if the service is covered. The next flag is describes whether a code can be broken down in the professional and technical components as described above. The next flag describes whether there are discounts on multiple procedures performed at the same time.
When a code is surgical, the Global Surgery Period, pre-, intra-, and post-op percentages, and bilateral, co-surgeon, assistant, and team modifiers if applicable, are displayed. If the procedure is an endoscopy, the endoscopic base code is included since endoscopies are considered related if they have the same endoscopic base code.