Physician Fee Schedule National Payment Amount 2018

$179 / year

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.

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

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

Payment Amount 2018, National Physician Fee Schedule 2018, Medicare Payment Amount 2018, National Physician Fee Schedule 2018, Physician Fee Schedules, CMS National Payment Amount, Physician Fee Schedule 2018, HCPCS Code, Cost Analysis, Cost Management

Other Titles

Physician Fee Schedule National Payment Amount, Facility Practice Expense 2018

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 : Ordinal
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).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
Outpatient_Prospective_Payment_System_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 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
0220200G0128773RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
0240202G0128993RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
1030235G0128773RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
0720299G0250992RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
1020299G0250992RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
1328299G0250992RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
1230299G024893933RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".000900
10202993820583830RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".200900
12402013820594940RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".200900
13292043820699990RRestricted Coverage: Special coverage instructions apply. If no RVUs are shown, the service is carrier priced. The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D".200900