08-05-2025
Your Guide to Navigating the Medicare Physician Fee Schedule Tool
The Centers for Medicare & Medicaid Services (CMS) physician fee schedule tool allows healthcare professionals and community-based organizations to find payment information for many Original Medicare services.
The Centers for Medicare & Medicaid Services (CMS) updates the physician fee schedule (PFS) each year. This provides physicians and community-based organizations (CBOs) with a search tool to find the most up-to-date reimbursement rates for various services covered by Original Medicare (Part A and Part B).
What is the PFS?
The PFS is the main method of payment for healthcare professionals who are enrolled in Medicare. Medicare uses the PFS when paying for the following Original Medicare services:
diagnostic tests
radiology services
services provided by auxiliary personnel, like nurses, or by nonphysician practitioners, like nurse practitioners
professional services by physicians and other healthcare professionals in a private practice
A note on Medicare Advantage
Medicare Advantage (Part C) may have different reimbursement rates. It is important to check with each plan for its specific rates and requirements.
About the PFS lookup tool
The CMS provides a PFS lookup tool for physicians and CBOs to find Medicare payment information for more than 10,000 services. These services include:
payment policies
pricing
associated relative value units (RVUs), used to help determine payment for physicians
CBOs may find the lookup tool useful to find reimbursement rates for their specific services, such as:
diabetes self-management training (DSMT)
chronic care management (CCM)
health behavior assessment and intervention (HBAI) services
PFS example 1
The following steps show an example of how to use the PFS lookup tool.
Go to the PFS lookup tool overview and click the 'Begin Search' button. This will take you to the license for use of current procedural terminology. Scroll down and press 'Accept.' Once you do, you will reach the search tool.
For this example, we will search for the reimbursement rate for group DSMT.
Dropdown options in PFS lookup tool
The PFS lookup tool gives dropdown options for:
year
type of information
pricing information
payment policy indicators
relative value units
geographic practice cost index
HCPCS code and criteria
single code
list of codes
range of codes
modifier
Medicare Administrative Contractor (MAC) option
national payment amount
specific MAC
specific locality
all MACs
Let's look at this example together:
For the year, ensure that the current year (2025) is selected.
In the type of information box, select pricing information.
For the HCPCS criteria, ensure that single HCPCS code is selected, then type in G0109.
Modifiers indicate whether a service was altered by a specific circumstance but didn't change its code or definition. Select all modifiers.
For the MAC option, select national payment amount.
Click the Search Fees button.
Search results
The search results show a lot of data. However, for this example, we will focus on the non-facility price, displayed in the results table.
The term 'non-facility' means a service was provided in an office. There may also be a 'facility price,' which means the service was provided in a hospital or ambulatory surgical center.
We are focusing on the non-facility price for this example because this type of DSMT is an outpatient service covered by Medicare Part B.
The search shows us that non-facility group DSMT is reimbursed at a rate of $15.20 per person, per 30 minutes.
These services may be subject to coinsurance. For most Part B services, the beneficiary is responsible for paying 20% of the Medicare-approved costs, leaving 80% for Medicare to pay.
PFS example 2
For this example we will change up our search a bit. This time we will search for two HCPCS codes. We will use the same group DSMT code of G0109 and add an individual DSMT code of G0108. Both of these are billed in 30-minute increments.
This time, we want to find the pricing for a specific location. For this example, we will focus on the Los Angeles area.
Let's look at this example:
Keep the current year (2025).
For the type of information, once again, select pricing information.
The HCPCS criteria select list of HCPCS codes.
This makes two boxes appear. In the first box, put G0108. In the second box, type G0109.
For the modifiers select all modifiers.
For the MAC option, select specific locality.
From the MAC locality dropdown, select 0118218 Los Angeles-Long Beach-Anaheim.
Search results
This time, you can see that the results show the prices for each type of DSMT. The results also show the MAC locality.
This shows that the non-facility price for individual DSMT is $58.26 per 30 minutes. For the group DSMT, the non-facility price is $16.76 per person per 30 minutes.
Finding help
For more help and information about the PFS lookup tool, the CMS provides a quick reference guide.
Summary
The PFS is the main payment method for healthcare professionals enrolled in Medicare. The CMS provides a PFS lookup tool so healthcare professionals and CBOs can search for the most up-to-date reimbursement amounts for specific services.
The CMS updates the PFS each year.
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