Medicare Durable Medical Equipment, Drug and Nutritional Products and Prosthetic and Orthotic Supplies Coverage
Medicare Durable Medical Equipment Coverage
Medicare Drug and Nutritional Products Coverage
Medicare Prosthetic and Orthotic Supplies Coverage
Keywords
CMS Medicare Provider
DMEPOS Company
Referring DME Provider
Referring DMEPOS Provider
Medical Durable Medical Equipment Supplies
Medicare DMEPOS Fee Schedule
Medicare DMEPOS Requirements
Medicare Drug and Nutritional Products Suppliers
Medicare Prosthetic and Orthotic supplies
Utilization and Payment Data Medical Equipment and Supplies 2013
The Centers for Medicare & Medicaid Services (CMS) publishes the Provider Utilization and Payment Data: Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File referred here as “Referring Provider DMEPOS PUF” in efforts to make the healthcare system more transparent, affordable, and accountable.
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Last updated:January 20, 2021
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The dataset gives information on the utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code of DMEPOS products and services provided to Medicare beneficiaries as ordered by physicians and other healthcare professionals. The dataset is enriched with latitude and longitude for the providers. This Public Use File is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse. The data set identifies individual providers who referred DMEPOS specific services using their National Provider Identifier (NPI). The Referring Provider DMEPOS PUF data allow for many types of analyses to be performed, including, for example, summary analyses by provider specialty. These new data include information on 385,915 referring providers, over 100 million claims, and $11 billion in Medicare allowed payments for 2013. Internal Medicine and Family Practice are the largest referring specialties with more than 80,000 unique providers in each specialty prescribing DMEPOS products. These providers refer an average of 36 and 38 DMEPOS products, respectively, and make referrals to a higher number of DMEPOS suppliers than most other common specialties. Some examples include wheelchairs, walkers, oxygen supplies, nebulizers, and diabetes testing supplies, as wells as other products such as enteral/parenteral nutrition, inhalation solutions, and certain chemotherapy drugs. Cardiology and Urology specialists refer fewer unique products and have fewer unique suppliers. Additionally, the data show that allowed amounts for referred DMEPOS products vary among these specialty types, from a low of $12K for Physician Assistants to a high of $156K for Pulmonary Disease specialists (likely due to the large amount of oxygen and nebulizer supplies prescribed by these specialists). The DMEPOS data can be used for geographic comparisons of costs and utilization of DMEPOS services/products and when combined with data on the number of beneficiaries enrolled in Medicare Part B coverage, per capita averages can be calculated. Nationally, the per capita allowed amount for all DMEPOS was $343.70 per enrolled beneficiary. These data include information for common inpatient and outpatient services, all physician and other supplier procedures and services, and all Part D prescriptions. Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure. The data in the Referring Provider DMEPOS PUF covers calendar year 2013 and contains final-action Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
About this Dataset
Data Info
Date Created
2017-03-30
Last Modified
2017-06-08
Version
2017-06-08
Update Frequency
Irregular
Temporal Coverage
2013
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare & Medicaid Services;
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
CMS Medicare Provider, DMEPOS Company, Referring DME Provider, Referring DMEPOS Provider, Medical Durable Medical Equipment Supplies, Medicare DMEPOS Fee Schedule, Medicare DMEPOS Requirements, Medicare Drug and Nutritional Products Suppliers, Medicare Prosthetic and Orthotic supplies
Other Titles
Medicare Durable Medical Equipment, Drug and Nutritional Products and Prosthetic and Orthotic Supplies Coverage, Medicare Durable Medical Equipment Coverage, Medicare Drug and Nutritional Products Coverage, Medicare Prosthetic and Orthotic Supplies Coverage
Data Fields
Name
Description
Type
Constraints
Referring_NPI
National Provider Identifier for the referring provider on the DMEPOS claim.
string
-
Referring_Provider_Last_Name_Organization_Name
Last Name or Organization Name of the referring provider
string
-
Referring_Provider_First_Name
First Name of the Referring Provider
string
-
Referring_Provider_Middle_Initial
Middle Initial of the Referring Provider
string
-
Referring_Provider_Credentials
Credentials of the Referring Provider
string
-
Referring_Provider_Gender
Gender of the Referring Provider
string
-
Referring_Provider_Entity
Entity Type of the Referring Provider, Type of entity reported in NPPES. Entity type identifies referring providers registered as individuals or the referring providers registered as organizations.
string
-
Referring_Provider_Street_1
Street Address 1 of the Referring Provider, The first line of the referring provider’s street address, as reported in NPPES.
string
-
Referring_Provider_Street_2
Street Address 2 of the Referring Provider, The second line of the referring provider’s street address, as reported in NPPES.
string
-
Referring_Provider_City
City of the Referring Provider, The city where the referring provider is located, as reported in NPPES
string
-
Referring_Provider_State_Abbreviation
State Code of the Referring Provider, The state where the referring provider is located, as reported in NPPES
string
-
Referring_Provider_Zip_Code
Zip Code of the Referring Provider
string
-
Referring_Provider_Country_Code
Country Code of the Referring Provider
string
-
Referring_Provider_Specialty_Type
Specialty Type of the Referring Provider, Derived from the Medicare provider/supplier specialty code reported on all of the NPI's Part B non-institutional claims (DMEPOS and non-DMEPOS). For referring providers that have more than one Medicare specialty code reported on their claims, the Medicare specialty code associated with the largest number of services was used.
string
-
Referring_Provider_Specialty_Type_Flag
A flag variable that indicates the source of the Referring Provider Type: Medicare Specialty Code description and Taxonomy Code Classification description
string
-
Number_of_Suppliers
Number of Suppliers Rendering DMEPOS Products/Services
integer
level : Ratio
Number_of_Supplier_HCPCS
Number of Supplier HCPCS
integer
level : Ratio
Number_of_Supplier_Beneficiaries
Number of Beneficiaries Associated with Supplier DMEPOS products/services ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries
integer
level : Ratio
Number_of_Supplier_Claims
Number of Supplier DMEPOS Claims submitted by the supplier, reflecting products/services ordered by the referring provider. Aggregated records based on number_of_supplier_claims fewer than 11 are not included in the data file.
integer
level : Ratio
Number_of_Supplier_Services
Number of Supplier DMEPOS Services rendered by the supplier; note that the metrics used to count the number provided can vary from service to service.
integer
level : Ratio
Supplier_Submitted_Charges
The total charges that suppliers submitted for all DMEPOS products/services ordered by the referring provider.
number
level : Ratio
Supplier_Medicare_Allowed_Amount
Medicare Allowed Amounts for DMEPOS. Medicare allowed amounts include the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.
number
level : Ratio
Supplier_Medicare_Payment_Amount
Amount that Medicare paid after deductible and coinsurance amounts have been deducted. It is done for all supplier's DMEPOS line item products/services ordered by the referring provider.
number
level : Ratio
Durable_Medical_Equipment_Suppression_Indicator
A flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.
string
-
Number_of_Durable_Medical_Equipment_Suppliers
Number of suppliers rendering durable medical equipment products/services. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Durable_Medical_Equipment_HCPCS
Total number of unique durable medical equipment HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Durable_Medical_Equipment_Beneficiaries
Total number of unique beneficiaries associated with durable medical equipment claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data
integer
level : Ratio
Number_of_Durable_Medical_Equipment_Claims
Total number of durable medical equipment claims submitted by suppliers, reflecting services ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Durable_Medical_Equipment_Services
Total durable medical equipment products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
integer
level : Ratio
Durable_Medical_Equipment_Submitted_Charges
Durable Medical Equipment Submitted Charges, The total charges that suppliers submitted for all durable medical equipment products/services ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
number
level : Ratio
Durable_Medical_Equipment_Medicare_Allowed_Amount
The Medicare allowed amount for all durable medical equipment products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.
number
level : Ratio
Durable_Medical_Equipment_Medicare_Payment_Amount
Amount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's durable medical equipment line item products/services ordered by the referring provider. A blank indicates the value is suppressed.
number
level : Ratio
Prosthetic_And_Orthotic_Suppression_Indicator
A flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.
string
-
Number_of_Prosthetic_and_Orthotic_Suppliers
Number of suppliers rendering prosthetic and orthotic products/services. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Prosthetic_and_Orthotic_HCPCS
Total number of unique prosthetic and orthotic HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Prosthetic_and_Orthotic_Beneficiaries
Total number of unique beneficiaries associated with prosthetic and orthotic claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Prosthetic_and_Orthotic_Claims
Total number of prosthetic and orthotic claims submitted by suppliers, reflecting products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Prosthetic_and_Orthotic_Services
Total prosthetic and orthotic products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
integer
level : Ratio
Prosthetic_and_Orthotic_Submitted_Charges
The total charges that suppliers submitted for all prosthetic and orthotic products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
number
level : Ratio
Prosthetic_and_Orthotic_Medicare_Allowed_Amount
The Medicare allowed amount for all prosthetic and orthotic products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
number
level : Ratio
Prosthetic_and_Orthotic_Medicare_Payment_Amount
Amount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier prosthetic and orthotic line item products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.
number
level : Ratio
Drug_And_Nutritional_Suppression_Indicator
A flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.
string
-
Number_of_Drug_and_Nutritional_Products_Suppliers
Number of suppliers rendering drug and nutritional products/services. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Drug_and_Nutritional_Products_HCPCS
Total number of unique drug and nutritional product. HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
Total number of unique beneficiaries associated with drug and nutritional product claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data
integer
level : Ratio
Number_of_Drug_and_Nutritional_Products_Claims
Total number of drug and nutritional product claims submitted by suppliers, reflecting services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
integer
level : Ratio
Number_of_Drug_and_Nutritional_Products_Services
Total drug and nutritional products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
integer
level : Rato
Drug_and_Nutritional_Products_Submitted_Charges
The total charges that suppliers submitted for drug and nutritional products/services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
The Medicare allowed amount for drug and nutritional products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
Amount that Medicare paid suppliers after deductible and coinsurance amounts have been deducted for drug and nutritional line item products/services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.
number
level : Ratio
Data Preview
Referring NPI
Referring Provider Last Name Organization Name
Referring Provider First Name
Referring Provider Middle Initial
Referring Provider Credentials
Referring Provider Gender
Referring Provider Entity
Referring Provider Street 1
Referring Provider Street 2
Referring Provider City
Referring Provider State Abbreviation
Referring Provider Zip Code
Referring Provider Country Code
Referring Provider Specialty Type
Referring Provider Specialty Type Flag
Number of Suppliers
Number of Supplier HCPCS
Number of Supplier Beneficiaries
Number of Supplier Claims
Number of Supplier Services
Supplier Submitted Charges
Supplier Medicare Allowed Amount
Supplier Medicare Payment Amount
Durable Medical Equipment Suppression Indicator
Number of Durable Medical Equipment Suppliers
Number of Durable Medical Equipment HCPCS
Number of Durable Medical Equipment Beneficiaries
Number of Durable Medical Equipment Claims
Number of Durable Medical Equipment Services
Durable Medical Equipment Submitted Charges
Durable Medical Equipment Medicare Allowed Amount
Durable Medical Equipment Medicare Payment Amount
Prosthetic And Orthotic Suppression Indicator
Number of Prosthetic and Orthotic Suppliers
Number of Prosthetic and Orthotic HCPCS
Number of Prosthetic and Orthotic Beneficiaries
Number of Prosthetic and Orthotic Claims
Number of Prosthetic and Orthotic Services
Prosthetic and Orthotic Submitted Charges
Prosthetic and Orthotic Medicare Allowed Amount
Prosthetic and Orthotic Medicare Payment Amount
Drug And Nutritional Suppression Indicator
Number of Drug and Nutritional Products Suppliers
Number of Drug and Nutritional Products HCPCS
Number of Drug and Nutritional Products Beneficiaries
Number of Drug and Nutritional Products Claims
Number of Drug and Nutritional Products Services
Drug and Nutritional Products Submitted Charges
Drug and Nutritional Products Medicare Allowed Amount
Drug and Nutritional Products Medicare Payment Amount
Demos
