Novitas Fee Schedule: How to Look Up Your Rates

If you bill Medicare Part B for a visit in New Jersey, sooner or later you check a code against the Novitas fee schedule. Novitas Solutions is the Medicare Administrative Contractor for Jurisdiction L, and Jurisdiction L covers New Jersey, so the rate Medicare allows for a code in your state comes from Novitas, not from a national table alone. This post walks through what the schedule shows, how the lookup tool works, and what the locality means for a claim your office is about to post.

The Novitas fee schedule is the published list of what Medicare Part B pays for a procedure code, by locality, under the physician fee schedule. Novitas Solutions is the Medicare Administrative Contractor (MAC) for Jurisdiction H and Jurisdiction L. Jurisdiction L covers Delaware, the District of Columbia, Maryland, New Jersey, and Pennsylvania. A practice in New Jersey looks up a code on the Jurisdiction L fee schedule, not the Jurisdiction H table, because the two jurisdictions can carry different locality adjustments for the same code.

To look up a rate, a biller opens the fee schedule search tool on the Novitas website, enters the procedure code, the modifier if one applies, the date of service, the state, and the locality, and the tool returns the allowed amount for that combination. The same tool offers a full year PDF download of every code in a locality, so a billing team can pull the whole list once instead of searching code by code.

The fee schedule Medicare publishes each year sets the allowed amount for every CPT and HCPCS code a practice bills on a CMS-1500 claim. CMS provides the relative value units (RVUs) behind each code, and the local Medicare Administrative Contractor, Novitas Solutions for Jurisdiction L, applies a locality adjustment on top of those RVUs to produce the dollar rate for a given state and area. That is why the same code can pay a different amount in Pennsylvania than it does in New Jersey, even though both states sit inside the same jurisdiction.

The lookup tool lives on the Novitas website under the fee schedule page for Jurisdiction L. A biller can search one code at a time with its modifier and date of service, or download the full year file as a PDF for every locality at once. Either way, the number that comes back is the Medicare allowed amount, the figure payment posting should match once the remittance advice arrives.

The search tool asks for five pieces of information: the procedure code, a modifier if the code needs one, the date of service, the state, and the locality. Enter all five and the tool returns the allowed amount Medicare pays for that exact combination.

Two details trip people up. First, the date of service matters because rates change on January 1 of each year, and sometimes mid-year for specific codes, so a code checked in December can return a different number in January. Second, the locality is not the same as the state. New Jersey has more than one locality, and the rate for a code in one part of the state can differ from the rate in another, because the locality adjustment reflects regional cost differences, not the state line.

For a practice billing the same handful of codes every week, downloading the full year PDF file for the locality once, instead of searching code by code, is usually faster. The same file works as a reference during payment posting, when a biller wants to confirm a payer's answer against the Medicare allowed amount before moving to the next claim. A fee schedule rate is also a different number than the UCR, or usual, customary, and reasonable, rate some commercial payers use; for that comparison, see what does ucr mean in medical billing.

Novitas Solutions is the Medicare Administrative Contractor for two jurisdictions, H and L. New Jersey sits in Jurisdiction L, alongside Delaware, the District of Columbia, Maryland, and Pennsylvania. That assignment is what puts the Jurisdiction L fee schedule, not the Jurisdiction H one, in front of a New Jersey practice every time a biller looks up a code.

The jurisdiction matters for more than the rate. A New Jersey family practice, cardiology group, endocrinology practice, or chiropractic office all bill Medicare Part B through the same Jurisdiction L contractor, on the same CMS-1500 form, and all of them check the same fee schedule page for their locality. If your office also sees NJ FamilyCare Medicaid patients, that program sets its own fee schedule separately through the state, so a code that pays one rate on a Medicare Part B claim can pay a different rate on a NJ FamilyCare claim for the same patient visit. The exact timely filing limit on a Jurisdiction L claim is set in Novitas's own provider manual rather than a single public number; for how timely filing limits vary by state more broadly, see medical billing time limits by state.

Once a claim posts, the remittance advice tells you what Medicare paid against that code. If a biller already knows the Jurisdiction L rate from the fee schedule, a short pay or a surprise reduction is easy to catch the same day, instead of showing up weeks later in an aging report. What the payer paid, and what the patient owes, gets posted to the claim as soon as the payer answers, and if a line pays less than the fee schedule says it should, that claim shows up in collections follow-up with the payer, the same place every other open claim shows up.

A denial is a different problem than a short pay, but the fee schedule still matters. When a code gets rejected or bundled, the appeal needs to show why the billed code is the one the fee schedule and the payer's own policy support. A denied claim should show the payer's reason next to the fix, so the office can resubmit once that reasoning has been checked against the record. That is the kind of oversight our medical billing services nj are built to give practices billing Medicare Part B out of New Jersey.

Looking up one code at a time works for a single claim, but it slows down fast when a practice bills family practice, cardiology, or chiropractic codes every day. Many offices end up keeping a spreadsheet of common codes and their Jurisdiction L rates just to catch an underpayment without opening the lookup tool for every line.

That is close to how billing works inside Valian. The doctor picks the codes for the visit, and our billing team reviews the code pairing and any required modifier before the medical or chiropractic claim goes out electronically through the dashboard. Every claim gets that review before it leaves the practice, and every claim stays visible after it is sent: what was billed, what was paid, and what is still owed, by claim and by payer. We are not replacing the Novitas fee schedule as the source of the rate. We are making sure the claim that goes out matches the code the doctor chose and the modifier the payer expects, so the rate that comes back lines up with what your office already checked.

If fee schedule rates, payment posting, and collections follow-up all live in different places today, that is usually where our revenue cycle management services start, pulling the claim, the posted payment, and the open balance into one dashboard your billing team already uses. The same approach works for practices outside New Jersey through our medical billing services page, since the steps between a code and a posted payment don't change much from one jurisdiction to the next.

Your billing, streamlined in our software. Keep managing it yourself, or have us take it over. If you want to see how a Jurisdiction L claim moves from code to posted payment inside Valian, Book an office visit.

What is the Novitas fee schedule for 2026?

The 2026 fee schedule is the list of Medicare Part B allowed amounts Novitas publishes for Jurisdiction H and Jurisdiction L for the year, based on the CMS physician fee schedule RVUs plus the locality adjustment for each area. You can search a single code or download the full file as a PDF from the fee schedule page on the Novitas website.

What is a Medicare fee schedule?

A Medicare fee schedule is the published rate Medicare pays for a specific procedure code, before any patient coinsurance or deductible is applied. CMS sets the relative value units behind every code, and the local Medicare Administrative Contractor, Novitas Solutions in Jurisdiction L, applies the locality adjustment that turns those units into a dollar amount.

How can I find the CMS fee schedule for 2026?

CMS publishes the national physician fee schedule file, and Novitas publishes the Jurisdiction L version with the New Jersey locality adjustment already applied. The quickest path for a New Jersey claim is the lookup tool on the Novitas website, since it already carries the local adjustment the national CMS file does not show on its own.

How do I check the Medicare fee schedule?

Go to the fee schedule page on the Novitas website for your jurisdiction, enter the procedure code, modifier, date of service, state, and locality, and the tool returns the allowed amount. If you bill in more than one state, check the jurisdiction that matches where the service was rendered, since Jurisdiction H and Jurisdiction L can show different rates for the same code.