Medicare at your locality
Participating allowed amounts from the current PFS release, before sequestration, for the locality your ZIP resolves to. Lab codes use the Clinical Laboratory Fee Schedule.
Charge floor check
Are any of your charges below what a payer allows?
Paste your charge list and service ZIP. For each code, the check compares your charge with the locality-adjusted Medicare allowed amount, the payer contracts you enter as a percentage of Medicare, and optionally your state’s Medicaid FFS rate. With payers whose contracts pay the lower of your charge and their allowed amount, a charge below the allowed amount leaves the difference unpaid on every claim.
Your charge list is not stored
Codes, charges, volumes and payer terms are processed for this check and not saved. They are not placed in the page URL. A charge list needs no patient data, and columns that look like patient or claim identifiers are refused.
How the floor is set
The floor for a code is the highest allowed amount among the payers you mark as paying the lower of charge and allowed. A payer that pays its allowed amount whatever you charge is shown for comparison but never sets the floor. The shortfall is the floor minus your charge; with an annual volume, the check multiplies it out and sorts the list by annual dollars.
Contractor-priced codes
A carrier-priced code has no national amount. Where your MAC publishes a fee for your locality and Localis holds that file, the check uses it and labels it as the MAC’s figure.
No $0 floors
Bundled, excluded and unpriced codes show their outcome and stay out of the summary. A code with no allowed amount has no floor to fall below.
What this check does not decide
It shows the arithmetic, not a recommended charge. Whether a payer pays the lower of your charge and its allowed amount depends on that payer’s rules and your contract, so you confirm it payer by payer. Coverage and coding correctness are outside this calculation. To price one payer’s offer across your volumes instead, use Contract Check.