Physician Fee Schedule National Payment Amount 2017

$79 / year

This dataset contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2017. For more than 10,000 physician services; the dataset contains the different carriers and locality wise payment amount with specific indicators.

Complexity

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.

Date Created

2015-11-17

Last Modified

2017-07-01

Version

2017-07-01

Update Frequency

Quarterly

Temporal Coverage

2016-07 to 2016-09

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

CMS Centers for Medicare & Medicaid Services for Standard Reference, July 01, 2017.

Keywords

Payment Amount 2017, National physician fee schedule 2017, Medicare Payment Amount 2017, National Physician Fee Schedule 2017, Physician Fee Schedules, CMS National Payment Amount, Physician Fee Schedule 2017, HCPCS Code

Other Titles

Physician Fee Schedule National Payment Amount, Facility Practice Expense 2017

NameDescriptionTypeConstraints
Carrier_NumberA number assigned to a specific carrier.integerrequired : 1 level : Nominal
Locality_NumberA number assigned to a specific localityintegerlevel : Nominal
HCPCS_CodeCPT or Level 2 HCPCS number for the service.string-
Modifier53 = Discontinued Procedure - Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances, or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.string-
NonFacility_Fee_Schedule_AmountPayment amount for the non-facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017.numberlevel : Nominal
Facility_Fee_Schedule_AmountPayment amount for the facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017.numberrequired : 1 level : Nominal
Procedure_Status_CodeThis 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.integerlevel : Ordinal
Multiple_Surgery_IndicatorIndicates applicable payment adjustment rule for multiple procedures:stringrequired : 1
Fifty_Percent_Therapy_Reduction_Amount_NonInstitutionalPricing 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).numberrequired : 1 level : Ratio
Fifty_Percent_Therapy_Reduction_Amount_InstitutionalPricing amount that reflects 75 percent payment for the PE for services furnished in an institutional setting (services paid under section 1834 of the Act).numberrequired : 1 level : Ratio
OPPS_IndicatorIndicator for OPPS.numberrequired : 1 level : Nominal
OPPS_NonFacility_Fee_AmountThe 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.numberrequired : 1 level : Ratio
OPPS_Facility_Fee_AmountThe 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.numberrequired : 1 level : Ratio
Trailer_IndicatorValue of trailer indicator ( if CWF (Common Working File) selects a claim for crossover, it shall return a BOI reply trailer 29 to the Medicare contractor)numberlevel : Nominal
Carrier_NumberLocality_NumberHCPCS_CodeModifierNonFacility_Fee_Schedule_AmountFacility_Fee_Schedule_AmountProcedure_Status_CodeMultiple_Surgery_IndicatorFifty_Percent_Therapy_Reduction_Amount_NonInstitutionalFifty_Percent_Therapy_Reduction_Amount_InstitutionalOPPS_IndicatorOPPS_NonFacility_Fee_AmountOPPS_Facility_Fee_AmountTrailer_Indicator
43120G0250992R000900
43120G0454990A000900
431207010026991A000900
431207012026991A000900
350297030026661A000900
421257030026661A000900
431207032826991A000900
431207101026991A000900
431207103526991A000900
431207400026991A000900