Carrier-priced Procedures
What is a carrier-priced procedure?
Carrier-priced codes are those with a status code "C" on the Medicare Physician Fee
Schedule Database (MPFSDB). Sometimes referred to as the Medicare Physician Fee
Schedule Relative Value File, this database is available on the Centers for Medicare &
Medicaid Services' Website at the following address:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp 
Other than category III "T" codes, CMS establishes no fees for carrier-priced procedures.
For most carrier-priced procedures, WPS Medicare uses individual consideration when reviewing a carrier-priced procedure and may request medical records to assist in the evaluation and pricing. This occurs only after receipt of the claim. Therefore, providers that submit claims electronically
should indicate that documentation is available upon request. For those providers that
do not submit claims electronically, documentation must accompany the claim.
There are some carrier-priced (status code "C") codes that Wisconsin Physicians Service (WPS) Carrier Medical Directors (CMDs) have established fees for. The fees that have been established by the WPS CMDs are displayed the Physician Fee Schedule on the WPS Medicare Website.
Providers should bill the amount to Medicare that accurately reflects all costs associated
with providing the procedure for the beneficiary.
Page Last Updated: Monday, 09-Jun-2008 13:34:14 CDT
