The Physician/Supplier Procedure Summary (PSPS) dataset is a summary of all Part B Carrier and Durable Medical Equipment (DME) Center Claims processed through the Common Working File and stored in the National Claims History Repository (NCHR). The analyses focus on units of service and allowed charges and our calculation of allowed charges per unit. A model is built to project the future utilization and cost to Medicare for Current Procedural Terminology (CPT) 80101 QW from 2010 to 2019 for both the current state baseline and a model of Medicare savings if a payment threshold was to be implemented.
By limiting the number of Clinical Laboratory Improvement Amendments (CLIA) waived 80101 procedures that can be billed per patient visit, Medicare would experience savings due to the reduction in utilization of CLIA waived tests, and also a reduction in the accompanying confirmation tests of those performed in the physician’s office.
The dataset is arrayed by carrier, pricing locality, CPT, modifier 1, modifier 2, physician specialty, type of service, and place of service. The summarized fields are total services and charges, total allowed services and charges, total denied services and charges, and total payment amounts. The analyses focus on units of service and allowed charges and calculation of allowed charges per unit