How to create a current Medicare reference fee schedule (part 4)

Medicare provides public reference fee schedules for all kinds of medical services: E&M codes, laboratory and radiology services, DME, and drugs and injectables. 

Making your own Medicare fee schedule provides a ready reference for your practice payments.  The Medicare fee schedule has four components that are useful references for a pediatrician:

  • Part 1: the physician fee schedule (PFS), which contains fees for all RVU-containing CPT and HCPCS codes, like sick and well evaluation and management (E&M codes), immunization administration codes, and procedure codes.  
  • Part 2: laboratory schedule, which contains fees for lab work (like urinalysis, CBC, rapid strep, and other codes, generally in the 80000-89999 CPT range.)
  • Part 3: immunization and injectable schedule, which contains Medicare payments for Medicare-approved immunizations and injectable drugs.
  • Part 4: Durable medical equipment (DME), which contains Medicare payments for DME and supply codes.

Medicare fee schedule part 4: Durable Medical Equipment fee schedule

Go to
Select a time period. The latest data will have the most recent year and highest letter. In this particular case, since DME18-D (orange arrow) links to no updates, we will select DME18-C (green arrow) in this case.
Download the file (e.g.
In the zip file, open the DMEPOS file (e.g. DMEPOS_JUL.xls)
The relevant columns in this file are the HCPCS code column (column A), the HCPCS code description column (column DJ), and the appropriate state column for your state.
Each state has two columns, nonrural (NR) and rural (R). To determine if you're in a rural or nonrural location, look in the DMERuralZip file (e.g. DMERuralZip_Q32018). If your zip code is listed, then use the rural (R) payments as a guide.
Delete all state columns that are irrelevant for your location.
If you are in a rural area, combine the nonrural and rural fee schedules into a single column. If the rural column shows 0.00 (green arrow), the rural payment for that HCPCS is the same as the nonrural payment. If the rural column shows a nonzero value (orange arrow), the higher rural column payment applies to rural areas.
To simply combine the rural/nonrural fees in this way, you can create a formula to take the maximum of the two columns into a third column.
To propagate the formula down to the bottom of the sheet, select the cell with the formula, Ctrl-C to copy it, click on an empty cell, drag down to the bottom, then type Ctrl-V.
To save the values so you can delete the two source columns, select the resulting column (here column J),
Now you can delete the two source columns.
Copy and paste the columns so that the HCPCS code is in column A, the HCPCS description is in column C, and the payment column is in column F.
Select the three resulting DME columns and copy them.
Paste the data to the bottom of the PFS data.