NGS Medicare Fee Schedule Lookup Walkthrough
Medicare Part B deductible for 2026 is $283.00
Advertisement
Which locality am I?
If you are unsure of your locality, Medicare divides the states into several geographic Localities based on the location of your practice. Illinois consists of payment localities 12, 15, 16, and 99. A listing of the counties comprising each payment locality follows:
Locality 12
Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. Clair, and Washington
Locality 15
DuPage, Kane, Lake, and Will
Locality 16
Cook
Locality 99
All other counties
Transcript:
I’m going to do a very quick walk-through on how to get the Medicare Fee Schedule for 2026. It’ll actually hold true in future years, but because NGS seems to be shifting some of the numbers, we want to make sure that you are able to get the most recent, up-to-date information. If you’re asking if Congress is going to make any adjustments, all bets are off on that, not something I want to speculate about. So instead, I’m just going to give you a quick walk-through on how to get the fee schedule from NGS. And the quickest way to do that is actually go to NGS’s lookup. We’ll include that link down below so you’ve got quick access to it, but it’s their lookup tool.
First thing it’s going to do is ask you where you know, what are, and where are you located? You’re a part B provider. Of course, you’re located in Illinois, unless you happen to be watching this video outside of Illinois. Then select your own, your own state, but make sure that if you are outside of Illinois, that you’re actually an NGS state and you don’t have a different Medicare carrier. So in this case, Part B, Illinois, go ahead and click the Select button, and the fee schedule lookup comes up. Now, in this case, you want to make sure that you just go ahead and select the top, and you’re going to select the Medicare Physician Fee Schedule pricing for the fee schedule. Ignore the other ones at this stage, and we’re going to go ahead and do specific to fee code, because it’s Medicare. We’re really only talking about three codes, right? We’re only talking about it 98940, 98941, 98942, for Medicare.
And so your data service this is super important. You want to make sure that you are including a date that is in 2026. Go ahead and just include a date that is passed. I typically would do like maybe the 15th, and then 2026 for the date. And then, of course, select your procedure code. In this case, we’re going to look up 98940, and then followed by your area. And in this case, you want to do area 12, 15, 16, or 99, and to make sure you select the right area, I’ll include a chart in this video as well that shows you what your area is based on the county that you live in. So if you’re in area 12, that’s the sample that we’re going to give at that point in this search. Go ahead and click search, and you will see the fee schedule gets dropped down below.
Super important, if you are a participating provider, your best option in all of this, so always make sure that your claims are processed appropriately. Is just to bill your standard office fee. Don’t mark it down to the Medicare amount. If you’re a participating provider with Medicare, just bill your standard office fee, whatever it may be; they will do the write-down for Medicare, and you’ll be taken care of however. We understand that there is a challenge for those who are not participating or non-participating, non-par with Medicare, and in those cases, you have the limiting charge that you do have to be concerned with. And so you want to choose in any of the fee schedules that you choose, you want to make sure that you choose the non-facility, the non-FAC. And here are the three that you’re going to be looking at. Ignore the last three in this column and ignore the OPPS capped payment rates. We’re really looking at the non-opps fee schedule.
So in this case, what you want to do is, for those who are non-participating, here is your limiting charge. LC stands for limiting charge. There is a limiting charge, but this is how you pull up the fee schedule when you want to then get 98941, you can go ahead and select 98941, and at that stage you’ll get the 98941, fee schedule, and you’ll see it’s verified here, 9941 here’s the effective date of this fee schedule, and it gives you a short description of this particular we’ll call it a Hicks pics code for this, for this purposes, and and then ultimately, here is the non facility limiting charge for 98941 as well as the other two payments. What, you know, what Medicare is going to base the reimbursement for the non-participating reimbursement for the patients after you collect your limiting charge, or what, ultimately, the Medicare is going to base the allowable amount for those who are participating.
But again, let me reiterate again, because it’s super important, if you are a participating provider with Medicare, make sure, please that you that you just bill your standard office fee. That’s not telling you what to bill. I’m telling you how to bill in this particular case. So hopefully this information will help you out and give you the quick walk-through. Again, I’ll include the link on exactly where the NGS lookup is, as well as the chart for your county, as related to what locale or region that you’re located in, and just choose the appropriate region, and you’ll be set, and we will catch you next week.
