Latest Fee Revisions: 10/01/2009.

Download files containing the 2009 Medicare Fee Schedule and Limiting Charge information for:

• Delaware (DE) 
• District of Columbia Metropolitan Area (DCMA) 
• Maryland (MD) 
• New Jersey (NJ) 
• Pennsylvania (PA) 

For Part B services, A/B MAC Jurisdiction 12 includes the Counties of Arlington and Fairfax in Virginia and the City of Alexandria in Virginia. Services for the remainder of the state of Virginia will be covered under A/B MAC Jurisdiction 11.

If you are looking for fee schedules for other contract areas, please visit the CMS site for additional information.

These files include the fees and limiting charges effective for services rendered on or after January 1, 2009. The fee schedule file is a tab delineated text file. It can easily be opened in a spreadsheet or word processing package.

Details about this year's Fee Schedule 

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Delaware has one payment area for physician services. Charge class 01 consists of the entire state.

2009 Delaware Fee Schedule - Charge Class 01:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP) 

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District of Columbia Metropolitan Area (DCMA) has one payment area for physician services. Charge class 01 consists of the following areas:

• Arlington and Fairfax counties in Virginia
• The city of Alexandria
• The District of Columbia
• Montgomery and Prince George's counties in Maryland.

2009 DCMA Fee Schedule - Charge Class 01:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)

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Maryland has two payment areas for physician services. They are charge classes 01 and 99.

• Maryland charge class 01 consists of the following counties:
  • Anne Arundel
  • Baltimore
  • Carroll
  • Harford
  • Howard
• Maryland charge class 99 covers the remainder of the state.

2009 Maryland Fee Schedule - Charge Class 01:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)
2009 Maryland Fee Schedule - Charge Class 99:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)

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New Jersey has two payment areas for physician services. They are charge classes 01 and 99. 

• New Jersey charge class 01 consists of the following counties:
  • Bergen,
  • Essex,
  • Hudson,
  • Hunterdon,
  • Middlesex,
  • Morris,
  • Passaic,
  • Somerset,
  • Sussex,
  • Union,
  • Warren.
• New Jersey charge class 99 covers the remainder of the state.

2009 New Jersey Fee Schedule - Charge Class 01:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)
2009 New Jersey Fee Schedule - Charge Class 99:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)

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Pennsylvania has two payment areas for physician services. They are charge classes 01 and 99.

• Pennsylvania charge class 01 consists of the following 5 counties:
  • Bucks
  • Chester
  • Delaware
  • Montgomery
  • Philadelphia
    
• Pennsylvania charge class 99 covers the remainder of the state.

2009 Pennsylvania Fee Schedule - Charge Class 01:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)
2009 Pennsylvania Fee Schedule - Charge Class 99:   PDF Format |  Text-Delimited (.ZIP) |  Microsoft Excel (.ZIP)

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Here are some details about this year's Fee Schedule:

Below are the column headings and descriptions of the information provided in each column of the report.

Note: The non-participating fee schedule and limiting charge do not apply to practitioners.

• Code: The procedure codes used are from the Centers for Medicare & Medicaid Services (CMS) Common Procedure Coding System (HCPCS). The five-digit numeric codes were obtained from the Physician’s Current Procedural Terminology (CPT). The alpha-numeric codes were developed by the Health Care Financing Administration.
• Par Fee: This is the allowance for participating providers before the application of co-insurance or payment limitations.
• NonPar Fee: This is the allowance for non-participating providers before the application of co-insurance or payment limitations. This amount is 95 percent of the participating allowance.
• LC: This is the Limiting Charge. This is the maximum amount that non-participating providers may bill their Medicare patients on non-assigned claims. For 2009, the limiting charge is always equal to 115 percent of the non-participating allowance.

Looking for more detailed fee information? Access CMS's Fee Schedule Look-Up site.

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Payment allowance for procedures not included on this report may be requested by writing to the following addresses:

Highmark Medicare Services
PO Box 890413
Camp Hill, PA 17089-0413

Beginning January 1, 2009, you may obtain fee schedule and Limiting Charge information for 5 or fewer procedure codes by calling our customer services telephone lines.

Note: The customer service representatives will verify your fees and Limiting Charge on line.