Medicare Payment

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Medicare Payment

Medicare payment varies based on the type of service, site of service, and benefit covering the service.

For specific information about how Medicare pays for certain services related to Lexiscan^® (regadenoson) injection, click here. For quarterly allowable for Lexiscan, click here.

Site of Service	Payment Methodology
Hospital Inpatient	Medicare Severity Diagnosis Related Group (MS-DRG) A classification system that groups patient encounters according to diagnosis, type of treatment, age, and other relevant criteria. Hospitals are paid one set fee for the patient, encounter based on the MS-DRG, regardless of the actual cost of care for the individual.
Skilled Nursing Facility	Resource Utilization Group (RUG) Per diem payments for each admission are case-mix adjusted using a resident classification system based on data from resident assessments and relative weights developed from staff time data.
Hospital Outpatient	Ambulatory Payment Classification (APC) Services in each APC are similar clinically and in terms of the resources they require. A payment rate is established for each APC. Depending on the services provided, hospitals may be paid for more than one APC for an encounter.
Physician Office	Medicare Physician Fee Schedule based on Resource-Based Relative Value System (RBRVS) A scale of national uniform relative values for all physicians' services. The relative value for each service includes physicians' work, practice expenses net of malpractice expenses, and the cost of professional liability insurance. Medicare multiplies the relative values by a conversion factor, and adjusts that amount geographically to determine the fee schedule amount.

Additional information about Medicare is available online at www.cms.hhs.gov or www.medicare.gov.

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