U.S. Medicare Reimbursement Searchable Database for specific procedures (DRG or CPT)

F

Frodeno

It`s so confusing..I think I started to hallucinate after spending a hour or so following links on the CMS website without success!!

I`ve been thrawling through the various .gov sites searching for information on reimbursement. Specifically I would like to be able to search for the dollar amount reimbursed by medicare to the hospital for specific procedures (DRG or CPT codes). I`m pretty sure that I did this a few years ago but just can`t seem to figure it out. Can anyone point me in the right direction?


Thanks in advance,

Frodo
 

Stijloor

Leader
Super Moderator
Re: U.S. medicare reimbursement searchable database

A Quick Bump!

Can someone help?

Thank you very much!
 
R

reimbursementnerd

Re: U.S. Medicare Reimbursement Searchable Database

What you're looking for is referred to as a Fee Schedule, best place to go for Medicare rates would be cms.gov/Medicare/Medicare.html

But here is the link to Oct 2016 OPPS payment spreadsheet (you'll want to download the .xlsx files, not the .csv ones) which have common hospital procedure codes with associated payment rates and co-pay values. This is most likely what you were looking for:

**this is my first post so I'm unable to post links, however the link is (just delete the spacing after.gov and before Medicare):

https://cms.gov/Medicare/Medicare-F...=1&DLEntries=10&DLSort=2&DLSortDir=descending

Not all procedures will have fees listed as certain CPT/HCPCS codes have "bundled rate" reimbursement (meaning some procedures aren't reimbursed because they a considered a subsequent component of another procedure which IS reimbursed) which is certainly a common occurrence in the hospital setting.

Navigating through the CMS website is not an intuitive process, and CY2016 uploads/transmittals were noted to be less coherent than others in years past. Let me know if you are unable to locate the fee schedules for your specific procedures and I'll try to hunt them down for you.

Hope this helps!
 
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