US · guidance

CMS Pub. 100-04, ch. 12, § 20.4

Summary of Adjustments to Fee Schedule Computations

activein force · 2026-08-25 – presentas-observed

For services prior to January 1, 1994, A/B MACs (B) computed the fee schedule amount for

every service. Through 1995, the fee schedule amount is the transition fee schedule amount.

For services after 1995, CMS computes and provides the fee schedule amount for every service

discussed above.

Certain adjustments are made in order to arrive at the final fee schedule amount.

Those adjustments are:

• Participating versus nonparticipating differential;

• Reduction for re-operations;

• Site of service payment adjustment;

• Multiple surgeries;

• Bilateral surgery;

• Anti-Markup Payment Limitation;

• Provider providing less than global fee package;

• Assistant at surgery;

• Two surgeons/surgical team; and

• Supplies.

History

(Rev. 1931, Issued: 03-12-10, Effective: 06-14-10, Implementation: 06-14-10)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: 70e4a36811f8e84e962693827548ae76a67adb699b2b3c6d0cd0d28cd225f8c4

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