Others titles
- Physician Supplier Procedure Summary Data
- DME Supplier Services
- Durable Medical Equipment Supplier Services
Keywords
- PSPS
- Physician Supplier Procedure Summary
- Healthcare Claims
- Part B Carrier
- Healthcare Common Procedure Coding System
- HCPCS Modifiers
- Provider Specialty
- Place of Service
- CPT
Physician Supplier Procedure Summary 2018
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.
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Description
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
About this Dataset
Data Info
Date Created | 2018-08-27 |
---|---|
Last Modified | 2019-08-28 |
Version | 2019-08-28 |
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 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
HCPCS_Code | The 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 | - |
Modifier | A 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_Code | CMS specialty code used for pricing the line item service on the noninstitutional claim. | string | - |
Carrier_Number | The identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier. | integer | level : Ratio |
Pricing_Locality_Code | Code 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_Code | Code 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_Code | The code indicating the place of service, as defined in the Medicare Carrier Manual, for this line item on the noninstitutional claim. | integer | level : Ratio |
HCPCS_Second_Modifier | A 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_Count | The count of the total number of submitted services. | number | level : Ratio |
PSPS_Submitted_Charge_Amount | The amount of charges submitted by the provider to Medicare. | number | - |
PSPS_Allowed_Charge_Amount | The amount that is approved (allowed) for Medicare. | number | - |
PSPS_Denied_Services_Count | The count of the number of submitted services that are denied by Medicare. | number | level : Ratio |
PSPS_Denied_Charge_Amount | The amount of submitted charges for which Medicare payment was denied. | number | - |
PSPS_Assigned_Services_Count | The count of the number of services from providers accepting Medicare assignment. | number | level : Ratio |
PSPS_NCH_Payment_Amount | The amount of payment made from the trust fund (after deductible and coinsurance amounts have been paid). | number | - |
Is_PSPS_HCPCS_ASC_Indicator_Code | A T/F code used to indicate whether the procedure is approved to be performed in an Ambulatory Surgical Center (ASC). | boolean | - |
PSPS_Error_Indicator_Code | The code used to indicate combinations of errors in key fields. | integer | level : Nominal |
HCPCS_BETOS_Code | This 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 | - |
Data Preview
HCPCS Code | Modifier | Provider Specialty Code | Carrier Number | Pricing Locality Code | Type of Service Code | Place of Service Code | HCPCS Second Modifier | PSPS Submitted Services Count | PSPS Submitted Charge Amount | PSPS Allowed Charge Amount | PSPS Denied Services Count | PSPS Denied Charge Amount | PSPS Assigned Services Count | PSPS NCH Payment Amount | Is PSPS HCPCS ASC Indicator Code | PSPS Error Indicator Code | HCPCS BETOS Code |
L5650 | LT | 51 | 19003 | 38 | P | 12 | K2 | 1 | 671.39 | 554.87 | 0 | 0 | 1 | 435.02 | False | 0 | D1F |
L3923 | CG | 54 | 19003 | 5 | P | 12 | LT | 7 | 663.97 | 540.75 | 0 | 0 | 7 | 423.92 | False | 0 | D1F |
25115 | LT | 49 | 4112 | 4 | F | 24 | 51 | 3 | 29045.0 | 1126.02 | 0 | 0 | 3 | 882.78 | True | 0 | P3D |
15839 | GC | 4 | 12502 | 1 | 2 | 24 | 51 | 1 | 2090.0 | 408.54 | 0 | 0 | 1 | 320.29 | True | 0 | P1G |
99306 | AI | 11 | 882 | 7 | 1 | 31 | 11 | 3423.0 | 2065.44 | 0 | 0 | 11 | 1619.31 | False | 0 | M4B | |
28270 | 79 | 48 | 13292 | 4 | 2 | 11 | 4 | 2300.0 | 2229.71 | 0 | 0 | 4 | 1682.04 | True | 0 | P5B | |
19303 | LT | 2 | 15202 | 0 | 2 | 24 | 4 | 10027.0 | 3872.32 | 0 | 0 | 4 | 3035.88 | True | 0 | P1A | |
L2200 | KX | 54 | 19003 | 17 | P | 12 | LT | 2 | 116.5 | 86.3 | 0 | 0 | 2 | 67.66 | False | 0 | D1F |
A4373 | 54 | 17013 | 15 | P | 32 | 350 | 2624.84 | 2471.0 | 0 | 0 | 350 | 1937.25 | False | 0 | D1F | ||
27829 | RT | 20 | 9102 | 99 | 2 | 21 | 59 | 6 | 15626.88 | 2880.56 | 0 | 0 | 6 | 2255.66 | True | 0 | P3D |