09/08/2021
Emergency Room Visit-MCR & Commercial Fees
I am trying to find the Medicare and Commercial Physician fee for Emergency Room Visits. Where can I find this information?
For Medicare, there is a specific search tool on the NGS website that can be used to search for the reimbursement in a facility or non-facility place of service. For emergency room services, you would want to review facility reimbursement rates- non-facility only applies to services provided in an office, urgent care, or patient’s home. To use the search engine:
- Select “Medicare Physician Fee Schedule Pricing”
- Click on the radio dial for “Specific to Fee Code”
- Enter the DOS and CPT code
- Select “New York - Region 2” for services provided in Suffolk County
https://www.ngsmedicare.com/web/ngs/fee-schedule-lookup?lob=96664&state=97133®ion=93623
For commercial payers, the information on reimbursement is not typically published online. The fee schedules for services performed in facility and non-facility settings can typically be found as an addendum with your participating provider contract with a specific insurance. If the contract was issued some time ago, the provider services representative should be able to provide additional information if there is an updated fee schedule for the most up to date reimbursement rates.