Demos
Others titles
- National Physician Fee Schedule 2018
- Medicare Payment Amount 2018
- National Physician Fee Schedule 2018
- CMS National Payment Amount
- Physician Fee Schedule 2018
Keywords
- Physician Fee Schedules
- HCPCS Code
- Cost Analysis
- Cost Management
- Cost-benefit Analysis
- Medicare Cost
- Cost Value
- Medical Cost
Physician Fee Schedule National Payment Amount 2018
This dataset contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2018. For more than 10,000 physician services; the dataset contains the different carriers and locality wise payment amount with specific indicators.
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Description
The Centers for Medicare and Medicaid Services (CMS) determines the final relative value unit (RVU) for each code used in this dataset, which is then multiplied by the annual conversion factor (a dollar amount) to yield the national average fee. Rates are adjusted according to geographic indices based on provider locality.
This dataset includes the Facility and non-facility payment amount according to different carriers and locality for a specific CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) Codes.
About this Dataset
Data Info
| Date Created | 2015-11-17 |
|---|---|
| Last Modified | 2018-10-04 |
| Version | 2018-10-04 |
| Update Frequency |
Quarterly |
| Temporal Coverage |
2018-01 to 2018-12 |
| Spatial Coverage |
United States |
| Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
| Source License URL | |
| Source License Requirements |
N/A |
| Source Citation |
N/A |
| Keywords | Physician Fee Schedules, HCPCS Code, Cost Analysis, Cost Management, Cost-benefit Analysis, Medicare Cost, Cost Value, Medical Cost |
| Other Titles | National Physician Fee Schedule 2018, Medicare Payment Amount 2018, National Physician Fee Schedule 2018, CMS National Payment Amount, Physician Fee Schedule 2018 |
Data Fields
| Name | Description | Type | Constraints |
|---|---|---|---|
| Carrier_Number | A number assigned to a specific carrier. | string | - |
| Locality_Number | A number assigned to a specific locality | string | - |
| HCPCS_Code | CPT or Level 2 HCPCS number for the service. | string | - |
| Modifier | For diagnostic tests, a blank in this field denotes the global service and the modifiers identify the components. | string | - |
| Modifier_Description | Description of the modifier | string | - |
| NonFacility_Fee_Schedule_Amount | Payment amount for the non-facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017. | number | - |
| Facility_Fee_Schedule_Amount | Payment amount for the facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017. | number | - |
| Procedure_Status_Code | This column includes the Procedure Status Code. If, ‘A’ is listed in this column and indicates an Active Code, which means the code is paid if covered. | integer | level : Nominal |
| Multiple_Surgery_Indicator | Indicates applicable payment adjustment rule for multiple procedures. | string | - |
| Multiple_Surgery_Indicator_Description | Description of the multiple procedures. | string | required : 1 |
| Fifty_Percent_Therapy_Reduction_Amount_NonInstitutional | Pricing amount that reflects 80 percent payment for the PE for services furnished in office and other noninstitutional settings (services paid under section 1848 of the Act). | number | level : Ratiorequired : 1 |
| Fifty_Percent_Therapy_Reduction_Amount_Institutional | Pricing amount that reflects 75 percent payment for the PE for services furnished in an institutional setting (services paid under section 1834 of the Act). | number | level : Ratiorequired : 1 |
| Outpatient_Prospective_Payment_System_Indicator | Indicator for OPPS. | number | level : Nominalrequired : 1 |
| OPPS_NonFacility_Fee_Amount | The OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005. | number | level : Ratiorequired : 1 |
| OPPS_Facility_Fee_Amount | The OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005. | number | level : Ratiorequired : 1 |
| Trailer_Indicator | Value of trailer indicator (if CWF (Common Working File) selects a claim for crossover, it shall return a Beneficiary Other Insurance (BOI) reply trailer 29 to the Medicare contractor) | number | level : Nominal |
Data Preview
| Carrier Number | Locality Number | HCPCS Code | Modifier | Modifier Description | NonFacility Fee Schedule Amount | Facility Fee Schedule Amount | Procedure Status Code | Multiple Surgery Indicator | Multiple Surgery Indicator Description | Fifty Percent Therapy Reduction Amount NonInstitutional | Fifty Percent Therapy Reduction Amount Institutional | Outpatient Prospective Payment System Indicator | OPPS NonFacility Fee Amount | OPPS Facility Fee Amount | Trailer Indicator |
| 1112 | 5 | G0101 | 45.84 | 32.01 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 6 | G0101 | 45.84 | 32.01 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 7 | G0101 | 45.84 | 32.01 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 9 | G0101 | 46.51 | 32.38 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 51 | G0101 | 44.14 | 31.03 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 52 | G0101 | 44.73 | 31.38 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 53 | G0101 | 44.14 | 31.03 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 54 | G0101 | 40.03 | 28.81 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 55 | G0101 | 39.96 | 28.75 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 | ||
| 1112 | 56 | G0101 | 39.96 | 28.75 | 0 | A | Active Code: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. | 0 | 0 | 0 | 9 | 0 | 0 |