Physician Supplier Procedure Summary 2017

$179 / year

The Physician/Supplier Procedure Summary (PSPS) dataset is a summary of the calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The dataset is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service.

Complexity

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

Date Created

2018-08-27

Last Modified

2019-01-09

Version

2019-01-09

Update Frequency

Annual

Temporal Coverage

2018

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

PSPS, Physician Supplier Procedure Summary, Healthcare Claims, Part B Carrier, Healthcare Common Procedure Coding System, HCPCS Modifiers, Provider Specialty, Place of Service, CPT

Other Titles

Physician Supplier Procedure Summary Data, DME Supplier Services, Durable Medical Equipment Supplier Services

NameDescriptionTypeConstraints
HCPCS_CodeThe Health Care Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs.string-
ModifierA first modifier to the HCPCS procedure code to enable a more specific procedure identification for the line item service on the noninstitutional claim.string-
Provider_Specialty_CodeCMS specialty code used for pricing the line item service on the noninstitutional claim.string-
Carrier_NumberThe identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier.integerlevel : Ratio
Pricing_Locality_CodeCode denoting the carrier-specific locality used for pricing the service for this line item on the carrier claim (non-DMERC). For DMERCs, this field contains the beneficiary SSA State Code.string-
Type_of_Service_CodeCode indicating the type of service, as defined in the CMS Medicare Carrier Manual, for this line item on the non-institutional claim.string-
Place_of_Service_CodeThe code indicating the place of service, as defined in the Medicare Carrier Manual, for this line item on the noninstitutional claim.integerlevel : Ratio
HCPCS_Second_ModifierA second modifier to the HCPCS procedure code to make it more specific than the first modifier code to identify the line item procedures for this claim.string-
PSPS_Submitted_Services_CountThe count of the total number of submitted services.numberlevel : Ratio
PSPS_Submitted_Charge_AmountThe amount of charges submitted by the provider to Medicare.number-
PSPS_Allowed_Charge_AmountThe amount that is approved (allowed) for Medicare.number-
PSPS_Denied_Services_CountThe count of the number of submitted services that are denied by Medicare.numberlevel : Ratio
PSPS_Denied_Charge_AmountThe amount of submitted charges for which Medicare payment was denied.number-
PSPS_Assigned_Services_CountThe count of the number of services from providers accepting Medicare assignment.numberlevel : Ratio
PSPS_NCH_Payment_AmountThe amount of payment made from the trust fund (after deductible and coinsurance amounts have been paid).number-
Is_PSPS_HCPCS_ASC_Indicator_CodeA T/F code used to indicate whether the procedure is approved to be performed in an Ambulatory Surgical Center (ASC).boolean-
PSPS_Error_Indicator_CodeThe code used to indicate combinations of errors in key fields.integerlevel : Nominal
HCPCS_BETOS_CodeThis field is valid beginning with 2003 data. The Berenson-Eggers Type of Service (BETOS) for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services.string-
HCPCS CodeModifierProvider Specialty CodeCarrier NumberPricing Locality CodeType of Service CodePlace of Service CodeHCPCS Second ModifierPSPS Submitted Services CountPSPS Submitted Charge AmountPSPS Allowed Charge AmountPSPS Denied Services CountPSPS Denied Charge AmountPSPS Assigned Services CountPSPS NCH Payment AmountIs PSPS HCPCS ASC Indicator CodePSPS Error Indicator CodeHCPCS BETOS Code
11305767610216.02113748.0318.783249.92False0P6A
E0484NUA0190033.0P126312.0246.726193.44False0D1E
270965025910299.02223716631.454779.1363522.53False0I1F
9930611610299.0132972235615.2153748.433.08792.3972115925.43False0M4B
20240RT48310222151.011000.077.82161.01False0P5B
92134LT1888218.01115980.0168.561.0150.05132.16False0T2D
99306GV38610215.0131163351.122729.06162124.52False0M4B
64633SG4931021.0F245673362.844503.765634717.34True0P1G
27513RT201520222138133928.6739198.246.020374.03829956.58False0P3D
939712611118272.05223147.023.052.0102.0318.07False0I3F