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2017 Medicare Worksheet

Monday, July 24, 2017   (0 Comments)
Posted by: William Feagin
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I have updated the Medicare PPS code worksheet to include all allowed codes for each G-code. The Medicare Base PPS rate was increased for 2017 to $163.49. So, if you have not already done so, you may want to review your centers fee schedule for possible adjustment.


The 2017 South Carolina PPS Rates are:

Established Patients - $156.79

New Patients and Preventative Services - $210.35


Things to consider while working with spreadsheet

1)      “G0467” tab, I left the nurse level visit (99211) although it is NOT an allowed qualifying code.  I left it because as a center you are building your “market basket” for the centers G-code rate.

2)      “Add On Codes” tab – This is a starting list that can be modified to your center based on your “market basket.” These are charges that can be included in your calculations for G0466 and G0467. These are codes that we must be putting on claims but are not reimbursed because they are considered included in the encounter rate, we must put them on the claim because this is the information CMS uses to adjust the FQHC market basket for increases to the PPS base rate.  Professional Charges Only, do not include technical components that can be billed through part B.


Please let either Maurishka or myself know if you have any questions. A copy of this email and the worksheet will be added to the secure website under the Finance Network.


Have a great day and happy calculating!