(Learn what HCPCS codes are, what they look like and where to find them before you look them up.)
From this HCPCS lookup, you'll find three things: a description of each HCPCS code, the Relative Value Amount (RVU) and the Geogrphic Practice Cost (GPCI). When put together, they become the Physician Fee Schedule.
What is a Relative Value Amount (RVU)?
Each HCPCS code is given a value - an amount of money Medicare will pay a hospital or a physician for that service as an average. Then, cities and other geographic areas are assigned an RVU - relative value amount - that is a percentage, higher or lower, of the average HCPCS payment.
Here's how that works: Depending on where you live in, the RVU will be higher or lower than the average, based on the cost of doing business. So, for example, the cost of doing business is higher than average in New York City. The average = 1. The RVU for New York City might be 1.3. In Birmingham, Alabama, which has a much lower cost of doing business, the RVU might be .75.
What is a Geographic Practice Cost Index?
The GPCI is the amount paid for each HCPCS code once the average has been multiplied by the RVU. It's not a percentage - it's the actual dollar amount. Looking at Code X from above, the average coast (RVU = 1.0) might be $100. In New York City, where the RVU is 1.3, Code X is worth $130. In Birmingham, Alabama where the RVU is .75, Code X would be worth $75.
When combined, the code payment amount, the RVU and the GPCI result in physician's fees for every service or procedure they may provide to you, their patient. It's called the Physician Fee Schedule.
Remember, the Physician Fee Schedule only tells you what Medicare pays for these services. If you have private insurance, the amount paid to your doctor or hospital may be more or less.
When you do a HCPCS lookup, you can learn four things:
- You can use a HCPCS code to find out what service or procedure it represents.
- You can use a service or procedure to look up the HCPCS codes that might apply.
- You can find out how much Medicare pays a doctor and a facility in your area for that service or procedure (the RVU).
- You can find out the average amount paid across the US for that code.
Here's how to do your look-up for free:
- Step 1: You'll begin on an overview page that describes the material you're about to look up. Read through the information on the overview page, then click on START SEARCH.
- Step 2: On the next page, you'll find a title that says you are looking up CPT codes. These codes are mostly identical to HCPCS codes, although HCPCS includes additional codes for devices, ambulance services and durable medical equipment.
You'll find an End-Use License. In essence it tells you that you may look up these codes only for your personal information and that you cannot sell them to anyone else. There is additional legaleese which you should read through.
- Step 3: Click on ACCEPT or DON'T ACCEPT. If you click on DON'T ACCEPT, you will not be allowed access to the code lookup.
- Step 4: The next page is your search page. First you'll choose the year or portion of a year that you're looking up the codes for. Next you'll choose the kind of results you want. If you aren't sure, and you're comparing your own billing paperwork to pricing, then choose the GPCI for starters. If it turns out not to be what you want, you can return to look up another value.
You'll also need to choose a specific "carrier" or "locality." These are difficult to choose from because they are in a strange order. You may need to read through each possibility because they aren't really alphabetical. For example, I live in Central NY which isn't listed anywhere near New York. It's listed as "Rest of New York."
- Step 5: Input the HCPCS code you are trying to identify on the next page. Then choose ALL MODIFIERS since that will give you all the information about that code.
Continue looking up the codes you need. Record the information you need depending on what you will use them for.
If you need further explanations, CMS has a "cheat sheet" you can use called Help with Physician Fee Schedule Search. It's a pdf file.
Link to the instructions for: