Others titles

  • National Physician Fee Schedule 2019
  • Medicare Payment Amount 2019
  • National Physician Fee Schedule 2019
  • CMS National Payment Amount
  • Physician Fee Schedule 2019

Keywords

  • Physician Fee Schedules
  • HCPCS Code
  • Cost Analysis
  • Cost Management
  • Cost-benefit Analysis
  • Medicare Cost
  • Cost Value
  • Medical Cost

Physician Fee Schedule National Payment Amount 2019

This dataset contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2019. For more than 10,000 physician services; the dataset contains the different carriers and locality wise payment amount with specific indicators.

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Description

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.

About this Dataset

Data Info

Date Created

2015-11-17

Last Modified

2019-10-01

Version

2019-10-01

Update Frequency

Quarterly

Temporal Coverage

2019

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 2019, Medicare Payment Amount 2019, National Physician Fee Schedule 2019, CMS National Payment Amount, Physician Fee Schedule 2019

Data Fields

Name Description Type Constraints
Carrier_NumberHCFA-Assigned Identification Numberstring-
Locality_NumberIdentification of Pricing 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 2019.number-
Facility_Fee_Schedule_AmountPayment amount for the facility setting, as published in the Federal Register Fee Schedule for Physicians Services for CY 2019.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).number-
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 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 the 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

Data Preview

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
11125G0076 62.9662.960A000900
11126G0076 62.9662.960A000900
11127G0076 62.9662.960A000900
11129G0076 63.6863.680A000900
111251G0076 61.1261.120A000900
111252G0076 62.0962.090A000900
111253G0076 61.1261.120A000900
111254G0076 57.0457.040A000900
111255G0076 56.9256.920A000900
111256G0076 56.9256.920A000900