Physician Fee Schedule (PFS)
Physician Fee Schedule
The CMS Medicare reimbursement schedule for physician and certain non-physician practitioner services, published annually.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Acronym for
- Physician Fee Schedule
- Primary sources
- 2
- Workspace handoff
- ask d3 →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
The Medicare PFS is published each November for the following calendar year. It sets the allowed amount for each CPT/HCPCS code via Total RVUs × GPCI × Conversion Factor.
How it shows up in your practice
The PFS final rule contains code-specific changes that can shift practice revenue meaningfully (e.g., E/M revaluation in 2021, G2211 in 2024). Subscribe to MLN Matters articles to catch the annual changes.
Sources
- CMS — Physician Fee Schedule (PFS)https://www.cms.gov/medicare/payment/fee-schedules/physician
- CMS — PFS Relative Value Fileshttps://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
Look up PFS rates in Ask D3
Open ask d3 →Related terms
- BillingRVU (Relative Value Unit)The basic unit of measure used in the Medicare Physician Fee Schedule, composed of work, practice expense, and malpractice components.
- BillingConversion FactorThe dollar value multiplied by the geographically-adjusted Relative Value Unit to determine the Medicare-allowable amount for a service.
- BillingGeographic Practice Cost Index (GPCI)Geographic adjusters applied to each RVU component to reflect local cost variation in physician work, practice expense, and malpractice.
- BillingwRVUs (Work RVUs)The work component of the Relative Value Unit, reflecting the time, technical skill, mental effort, and stress required to perform a service.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryConversion FactorThe dollar value multiplied by the geographically-adjusted Relative Value Unit to determine the Medicare-allowable amount for a service.
- GlossaryGeographic Practice Cost Index (GPCI)Geographic adjusters applied to each RVU component to reflect local cost variation in physician work, practice expense, and malpractice.
- GlossaryRVU (Relative Value Unit)The basic unit of measure used in the Medicare Physician Fee Schedule, composed of work, practice expense, and malpractice components.
- GlossarywRVUs (Work RVUs)The work component of the Relative Value Unit, reflecting the time, technical skill, mental effort, and stress required to perform a service.
- GlossaryCardiac Stress Test (93015-93018)CPT codes for cardiac stress testing, with separate codes for the global service, supervision, and interpretation.
- GlossaryCharge CaptureThe process of identifying and recording every billable service furnished during a patient encounter.
- GlossaryClean Claim RatePercentage of claims accepted by the payer on first submission without edits or rejections.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.