HHS research pricing for patient care procedures provided to HHRI projects is based on reimbursement rates set by CMS/Medicare. To assist investigators in more easily identifying freqently used procedures, HCMC Revenue Integrity has developed a Medicare research fee schedule that contains all currently active procedure codes used for research. The currently active codes and pricing is available here: HCMC Research Fee Schedule. As new procedures are requested for research, they are added to this pricing list.
For procedure codes that are not yet active for research at HHS, pricing can be obtained through the CMS pricing tools detailed below. Institutional assistance is available in identifying codes from the Research IT Specialist who can be contacted at email@example.com.
CMS Physician Fee Schedule
The CMS Physician Fee Schedule website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). The Physician Fee Schedule look-up is designed to take you through the selection steps and to provide pricing amounts.
Clinical Laboratory Fee Schedule
Clinical laboratory services are paid based on a fee schedule in accordance with Section1833(h) of the Social Security Act. The Clinical Laboratory Fee Schedule is available for download and requires UNZIP software. When downloading use the most current year file (e.g., for 2015 download file 15CLAB.zip).
In addition to standard dispensing fees per dose of a medication, research pharmacy fees at HCMC also include the actual amount of time it requires the research pharmacy staff to set up and manage a study. The Research Pharmacy Pricing Worksheet will aid in determining costs for the proposed pharmacy work to be completed.
Fee for Research Order Set Builds
HHS clinical researchers whith complex and long-term protocols may request assistance from the HHS Electronic Health Record(EHR) team to create order sets. Pricing for this support is similar to the pricing process for the research pharmacy in that time spent building order sets for research is billed based on the actual amount of time expended. The HCMC Resource Utilization and Coverage Analysis Tool is a helpful document in assisting the EHR team to understand a protocol so they can provide realistic time estimates for the build. If a research orderset build is being contemplated for a new study, please contact the Research IT Specialist at firstname.lastname@example.org.