Physician Fee Schedule National Payment Amount 2017

$179 / 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

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 2017, Medicare Payment Amount 2017, National Physician Fee Schedule 2017, CMS National Payment Amount, Physician Fee Schedule 2017

NameDescriptionTypeConstraints
Carrier_NumberA number assigned to a specific carrier.string-
Locality_NumberA number assigned to a specific localitystring-
HCPCS_CodeCPT or Level 2 HCPCS number for the service.string-
ModifierFor diagnostic tests, a blank in this field denotes the global service and the modifiers identify the components.string-
Modifier_DescriptionDescription of the modifierstring-
NonFacility_Fee_Schedule_AmountPayment amount for the non-facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017.number-
Facility_Fee_Schedule_AmountPayment amount for the facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2017.number-
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 : Nominal
Multiple_Surgery_IndicatorIndicates applicable payment adjustment rule for multiple procedures.string-
Multiple_Surgery_Indicator_DescriptionDescription of the 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).number-
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
Outpatient_Prospective_Payment_System_IndicatorIndicator for OPPS.number-
OPPS_NonFacility_Fee_AmountThe OPPS Payment Amount calculated using these values is compared to the Medicare Physician Fee Schedule to determine the applicability of the OPPS Imaging Cap mandated by Section 5102(b) of the Deficit Reduction Act of 2005.number-
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.number-
Trailer_IndicatorValue 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)numberlevel : Nominal
Carrier NumberLocality NumberHCPCS CodeModifierModifier DescriptionNonFacility Fee Schedule AmountFacility Fee Schedule AmountProcedure Status CodeMultiple Surgery IndicatorMultiple Surgery Indicator DescriptionFifty Percent Therapy Reduction Amount NonInstitutionalFifty Percent Therapy Reduction Amount InstitutionalOutpatient Prospective Payment System IndicatorOPPS NonFacility Fee AmountOPPS Facility Fee AmountTrailer Indicator
11125G010146.9132.790AActive 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.000900
11126G010146.7132.670AActive 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.000900
11127G010145.4131.960AActive 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.000900
11129G010146.8732.810AActive 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.000900
111251G010144.8431.610AActive 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.000900
111252G010144.8631.630AActive 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.000900
111253G010144.8431.610AActive 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.000900
111254G010140.4829.250AActive 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.000900
111255G010140.4829.250AActive 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.000900
111256G010140.4829.250AActive 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.000900