The Medicare Physician Fee Schedule Database - WPS Medicare

The Medicare Physician Fee Schedule Database
The Centers for Medicare & Medicaid Service (CMS) has a resource designed to help providers
determine if a procedure code is payable by Medicare and how it should be reimbursed. It is
named the Medicare Physician Fee Schedule Database (MPFSDB) or the Relative Value Files.
The files are located on the CMS website on the PFS Relative Value Files page
(http://www.cms.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage) and cover 2003
through the current year. The files are typically updated quarterly and are named with the
effective year and an alpha character. For example, RVU11D is the file for Relative Value Units
(RVU) for the fourth quarter (D) of 2011 (11); see Figure 1, example A.
Figure 1
Example B
Revised
2012 File
Example A
4 th quarter
2011 Update
On occasion, CMS changes the files mid-quarter or before the quarter actually goes into effect,
then the file names will have the year, alpha representation of the quarter, and R for revised.
For example, RVU12AR is the revised file for the first quarter of 2012; see figure 1, example B.
Created 01/27/2012 1
http://www.wpsmedicare.com/

Figure 2
http://www.wpsmedicare.com
Use the scroll bar to
see the downloadable
section
Use the link to
open the file
Once you have selected the file for the date of service in question, scroll down and select the
link under the downloads section; see figure 2.
You will need to select “open” (see example 3) to allow the files to unzip.
Figure 3
Use the open button to
unzip the files.
This will open the file using the ZIP software available on your computer. See figure 4. A list of
16 different files will be displayed; however, at this time we are focused exclusively on the last
four. The files beginning PPRRVU are the Relative Value Files in different formats. We
recommend that you open the Microsoft Excel file displayed with suffix .xls or. xlsx.
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Figure 4
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The Key to reading the
file.
The database itself.
The Key to the Relative Value Files, giving the meaning of the indicators, is the last file
beginning RVUPUF, see figure 4. You will need to open both files.
Each column within a row of the Relative Value File relates to the procedure code displayed in
column A, see figure 5. The information shown explains how CMS establishes the fee (the RVU
columns), if the code is accepted by Medicare (status column), whether certain modifiers can be
used, and a variety of other information. To determine the meaning of the entries in each
column, refer to the Key, where a brief description is provided. Please note that the same
number or alpha character may have different meanings from one column to another.
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Figure 5
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Procedure codes
Status indicator, explaining if
Medicare recognizes a
procedure code
Scroll over to read more columns
Remember to check for updates throughout the year. Also, it is best not to print this file; simply
use the on-line version to ensure you are using the most current version.
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