Physician and Other Supplier Payment National HCPCS Aggregate Report

$199 / year

The dataset contains information on utilization and payments (Average submitted charges, Average Medicare allowed amount, Average Medicare Payment amount, Medicare standardized payment amount) on HCPCS codes on the national level. 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 in the Physician and Other Supplier PUF covers the calendar year 2012 to 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Complexity

Each year, in the United States, health care insurers process over 5 billion claims for payment. The HCPCS code is a standardized coding system that helps Medicare and other health insurance programs ensure the claims are processed in an orderly and consistent manner. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other healthcare professionals. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. The Physician and Other Supplier PUF and the supplemental summary tables including the “Medicare State/National HCPCS Aggregate Tables” have been updated to include Medicare standardized payment amounts.

Date Created

2017-09-22

Last Modified

2017-09-22

Version

2017-09-22

Update Frequency

Annual

Temporal Coverage

2012-2015

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

HCPCS Code, Place of Service, Aggregate HCPCS Table, Physician and Other Supplier, Utilization and Payment, National HCPCS Aggregate Table

Other Titles

National HCPCS Code and Place of Service Aggregate Report, National HCPCS Aggregate Report, Medicare Providers Utilization and Payment Data National Aggregate Report, Physicians And Other Suppliers National Aggregate Report

NameDescriptionTypeConstraints
YearYear of national HCPCS aggregate datadate-
HCPCS_CodeHCPCS code used to identify the specific medical service furnished by the provider. HCPCS codes include two levels. Level I codes are the Current Procedural Terminology (CPT) codes that are maintained by the American Medical Association and Level II codes are created by CMS to identify products, supplies and services not covered by the CPT codes (such as ambulance services). CPT codes, descriptions and other data only are copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).string-
HCPCS_DescriptionDescription of the HCPCS code for the specific medical service furnished by the provider. HCPCS descriptions associated with CPT codes are consumer friendly descriptions provided by the AMA. All other descriptions are CMS Level II descriptions provided in the long form. Due to variable length restrictions, the CMS Level II descriptions have been truncated to 256 bytes. As a result, the same HCPCS description can be associated with more than one HCPCS code.string-
Is_HCPCS_Drug_IndicatorIdentifies whether the HCPCS code for the specific service furnished by the provider is an HCPCS listed on the Medicare Part B Drug Average Sales Price (ASP) File.boolean-
Place_of_ServiceIdentifies whether the place of service submitted on the claims is a facility (value of ‘F’) or non-facility (value of ‘O’). Non-facility is generally an office setting; however other entities are included in non-facility.string-
Number_of_ProvidersNumber of providers in the country with HCPCS code and place of service.integerlevel : Ratio
Number_of_ServicesTotal provider services.numberlevel : Ratio
Number_of_Unique_Beneficiary_Or_Provider_InteractionsTotal Medicare beneficiaries receiving the provider services.integerlevel : Ratio
Number_of_Distinct_Medicare_Beneficiary_Or_Per_Day_ServicesSince a given beneficiary may receive multiple services of the same type (e.g., single vs. multiple cardiac stents) on a single day, this metric removes double-counting from the line service count to identify whether a unique service occurred.integerlevel : Ratio
Average_Submitted_Charge_AmountAverage of the charges that the provider submitted for the servicenumber-
Minimum_Submitted_Charge_AmountThe minimum submitted charge for the service.number-
Maximum_Submitted_Charge_AmountThe maximum submitted charge for the service.number-
Standard_Deviation_Of_Submitted_Charge_AmountStandard deviation of the charge amounts submitted by providers. The standard deviation indicates the amount of variation from the average submitted charge amount that exists within HCPCS code and place of service.number-
Average_Medicare_Allowed_AmountThis 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.number-
Minimum_Medicare_Allowed_AmountThe minimum Medicare allowed amount for the service.number-
Maximum_Medicare_Allowed_AmountThe maximum Medicare allowed amount for the service.number-
Standard_Deviation_Of_Medicare_Allowed_AmountStandard deviation of the Medicare allowed amount. The standard deviation indicates the amount of variation from the average Medicare allowed amount that exists within HCPCS code and place of service.number-
Average_Medicare_Payment_AmountAverage amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item service. Note: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incurred a 2 percent reduction in Medicare payment. This is in response to mandatory across-the-board reductions in Federal spending, also known as sequestration.number-
Minimum_Medicare_Payment_AmountThe minimum Medicare payment amount for the service.number-
Maximum_Medicare_Payment_AmountThe maximum Medicare payment amount for the service.number-
Standard_Deviation_Of_Medicare_Payment_AmountStandard deviation of the Medicare payment amount. The standard deviation indicates the amount of variation from the average Medicare payment amount that exists within HCPCS code and place of service.number-
Average_Medicare_Standardized_Payment_AmountAverage Medicare Standardized Amount which is the average amount that Medicare paid after beneficiary deductible and coinsurance amounts have been deducted for the line item service and after standardization of the Medicare payment has been applied.number-
YearHCPCS_CodeHCPCS_DescriptionIs_HCPCS_Drug_IndicatorPlace_of_ServiceNumber_of_ProvidersNumber_of_ServicesNumber_of_Unique_Beneficiary_Or_Provider_InteractionsNumber_of_Distinct_Medicare_Beneficiary_Or_Per_Day_ServicesAverage_Submitted_Charge_AmountMinimum_Submitted_Charge_AmountMaximum_Submitted_Charge_AmountStandard_Deviation_Of_Submitted_Charge_AmountAverage_Medicare_Allowed_AmountMinimum_Medicare_Allowed_AmountMaximum_Medicare_Allowed_AmountStandard_Deviation_Of_Medicare_Allowed_AmountAverage_Medicare_Payment_AmountMinimum_Medicare_Payment_AmountMaximum_Medicare_Payment_AmountStandard_Deviation_Of_Medicare_Payment_AmountAverage_Medicare_Standardized_Payment_Amount
2014A4565SlingsfalseFacility3113713313720.968.406.406.40
2015A4565SlingsfalseFacility2786868621.178.516.676.69
2015G6038SalicylatefalseFacility7191819959.669.479.47
201476497CT scanfalseFacility26434343295.0557.9245.4145.41
201488175Pap testfalseFacility1332323278.2335.8126.6426.91
201482330Calcium levelfalseFacility516161649.274.974.054.05
2015G6034DoxepinfalseFacility825242578.221.0920.6720.67
2014Q0114Fern testfalseOrganization2329262928.019.769.569.56
201588175Pap testfalseFacility1338383876.5535.4826.527.71
201576497CT scanfalseFacility38807980301.1953.3942.0142.01