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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
  • Reduce administration time

The modules allow for some data customization and reporting options to meet your needs.

Consulting Services
for States

Optum has an experienced team to help your state write and roll out a comprehensive fee schedule. 

Contact us today to learn more.

For more info email
ExpectMore@optum.com

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
 

OUR FEE SCHEDULE DATABASE IS DESIGNED TO:

  • Provide rapid updates via online database delivery. Optum specialists are in regular contact with agencies to collect and post new and/or updated fee schedules to your Optum customer website data vault. Schedule updates include published dollar amounts and/or relative values and conversion factors for the professional services of these fee schedules.
  • Deliver fee schedule data in a uniform format. By eliminating variable formats we provide unmatched ease in implementing state fee schedules for all available states.
  • Reduce administration time and better utilize your resources. We collect, standardize, and maintain data to help you make efficient use of your IT professionals’ resources and time.

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
New Jersey
New York
Oregon
Pennsylvania
Utah

PLUS FEATURES

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

For more info email
ExpectMore@optum.com

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:

The Optum module – and all new releases – are available through fast and convenient web downloads.

For more info email
ExpectMore@optum.com

SET UP YOUR OWN
FEE SCHEDULES
 

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.