CMS website

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  Identify the State Medicare carrier and obtain a copy of the Medicare Provider Program Fee Schedule and the Clinical Laboratory Fee Schedule for the current year.

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  NOTE: States with different “localities” should obtain applicable Medicare Provider Program Fee Schedules from each carrier for each locality.

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  Obtain annual updates of the Medicare fee schedule to ensure that the DDS fee schedule is current.

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  DDSs should obtain a copy of the CPT and purchase updates each year. The AMA publishes the CPT Codebook annually.

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  CMS bases Medicare fees upon services and procedures using CPT coding system.

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  The CPT Codebook is available from the AMA at the AMA Store

Use the DDS CE list of special examinations and ancillary studies to identify the CPT code used for the same or similar service.

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  Document the DDS code that matches the CPT code for each specific exam/ancillary study.

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  Annotate the CPT code as the control code. For each CPT control code, document the DDS fee along with each Medicare fee.

Using the Medicare fee schedule as the basis for the DDS fee schedule is not intended to increase the DDS CE fees. DDSs should negotiate the best possible fee for the service.

In States with different localities, it may not be necessary to create a different DDS fee schedule for each locality. The highest fee paid should not be readily adopted. The existence of different “locality” schedules may help the DDS negotiate more competitive rates with providers. If a DDS is unable to obtain providers in certain areas who will accept the Medicare rate, they should contact NDD for further guidance.

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  DDS should ensure NDD has a current copy of its fee schedule documentation.

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  Medicare fees are subject to change. When notified of any Medicare fee changes review the fee schedule and revise the chart.

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  Prepare a new chart when the new Medicare fees are published each year.

The following chart is an example of how to document the fee schedule regardless of whether it is based on the Medicare fee schedule or a State agency fee schedule.