State Fee Schedule Services
A fee schedule is a list of the maximum rate a payer will allow for services based on code sets such as CPT, HCPCS and CDT (dental) codes. The fee schedules are frequently updated and may vary by location within the state. They are important for organizations that adjudicate or review workers’ compensation and auto medical bills, those who want to set up their own fee schedules, and those who need to confirm reimbursement amounts to Medicare.
Optum offers two fee schedule modules: State Fee Schedule Plus and Medicare Physician Fee Schedule that deliver data in a uniform format and reduce administration time. The modules allow for some data customization and reporting options to meet your needs.
State Fee Schedule Plus module
The State Fee Schedule Plus Module is our solution for up-to-date and consistent fee schedule data constructed to serve organizations that adjudicate or review workers’ compensation and auto medical bills.
This helps you
- Implement state fee schedules with ease
- Obtain timely and consistent state fee schedule data
- Advance optimal bill review efficiently
The plus component of the State Fee Schedule Plus module offers a wealth of useful information including
- Extra information provided by the state
- Data based on coding and fee schedule intelligence and experience
- Summary and analysis of each state’s fee schedule rules and regulations
- Quality assurance review of the data
Available states
Workers’ compensation fee schedules
We offer state fee schedules for the District of Columbia, all 45 states that mandate workers’ comp and the Federal workers’ comp fee schedule (OWCP).
Auto fee schedules
Florida
Hawaii
Michigan
New Jersey
New York
Oregon
Pennsylvania
Utah
Medicare Fee Schedule module
A convenient tool to help you compare your own reimbursement schedule and review claims with greater efficiency and confidence.
The Optum Medicare Physician Fee Schedule module provides a convenient way to access the Resource-Based Relative Value Scale (RBRVS). The module serves organizations that need Medicare physician reimbursement information and allows for easy comparisons to other fee schedules.
RBRVS is a dynamic system that requires periodic updates due to ongoing changes of the Current Procedural Terminology (CPT®) codes, technology, medical practice, and other factors. Optum monitors the website for updates and our module helps you stay current and save time as you set up your own fee schedules and confirm your reimbursement amounts to medicare.
Standard and gap-fill versions
The Optum Medicare Physician Fee Schedule module is available in annual or quarterly updates and in Standard or Gap-fill versions.
The Standard Option provides geographically-adjusted Medicare Physician Fee Schedule amounts for all RBRVS-valued procedures. Optum provides a “crosswalk” from Medicare localities to the closest three-, five-, or nine-digit zip codes, thus allowing Medicare carrier and locality to be easily accessed.
The module consists of relational database tables and includes:
- Relative Value Units (RVUs)
- Geographic practice cost indices (GPCIs)
- National Conversion Factor
- Zipcode crosswalks to carrier and locality
The Gap-fill Option is similar to the Medicare Physician Fee Schedule, but for the thousands of services where an RBRVS value isn’t available, Optum uses information from other CMS data files and our own proprietary values to develop a relative value.