Utilization and Payment Data Medical Equipment and Supplies 2013

$447.50 / year

The Centers for Medicare & Medicaid Services (CMS) publishes the Provider Utilization and Payment Data: Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File referred here as “Referring Provider DMEPOS PUF” in efforts to make the healthcare system more transparent, affordable, and accountable. The dataset gives information on the utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code of DMEPOS products and services provided to Medicare beneficiaries as ordered by physicians and other healthcare professionals. The dataset is enriched with latitude and longitude for the providers.

Complexity

This Public Use File is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse. The data set identifies individual providers who referred DMEPOS specific services using their National Provider Identifier (NPI). The Referring Provider DMEPOS PUF data allow for many types of analyses to be performed, including, for example, summary analyses by provider specialty. These new data include information on 385,915 referring providers, over 100 million claims, and $11 billion in Medicare allowed payments for 2013. Internal Medicine and Family Practice are the largest referring specialties with more than 80,000 unique providers in each specialty prescribing DMEPOS products. These providers refer an average of 36 and 38 DMEPOS products, respectively, and make referrals to a higher number of DMEPOS suppliers than most other common specialties. Some examples include wheelchairs, walkers, oxygen supplies, nebulizers, and diabetes testing supplies, as wells as other products such as enteral/parenteral nutrition, inhalation solutions, and certain chemotherapy drugs. Cardiology and Urology specialists refer fewer unique products and have fewer unique suppliers. Additionally, the data show that allowed amounts for referred DMEPOS products vary among these specialty types, from a low of $12K for Physician Assistants to a high of $156K for Pulmonary Disease specialists (likely due to the large amount of oxygen and nebulizer supplies prescribed by these specialists). The DMEPOS data can be used for geographic comparisons of costs and utilization of DMEPOS services/products and when combined with data on the number of beneficiaries enrolled in Medicare Part B coverage, per capita averages can be calculated. Nationally, the per capita allowed amount for all DMEPOS was $343.70 per enrolled beneficiary. These data include information for common inpatient and outpatient services, all physician and other supplier procedures and services, and all Part D prescriptions. Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure. The data in the Referring Provider DMEPOS PUF covers calendar year 2013 and contains final-action Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.

Date Created

2017-03-30

Last Modified

2017-06-08

Version

2017-06-08

Update Frequency

Irregular

Temporal Coverage

2013

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

CMS Medicare Provider, DMEPOS Company, Referring DME Provider, Referring DMEPOS Provider, Medical Durable Medical Equipment Supplies, Medicare DMEPOS Fee Schedule, Medicare DMEPOS Requirements, Medicare Drug and Nutritional Products Suppliers, Medicare Prosthetic and Orthotic supplies

Other Titles

Medicare Durable Medical Equipment, Drug and Nutritional Products and Prosthetic and Orthotic Supplies Coverage, Medicare Durable Medical Equipment Coverage, Medicare Drug and Nutritional Products Coverage, Medicare Prosthetic and Orthotic Supplies Coverage

NameDescriptionTypeConstraints
Referring_NPINational Provider Identifier for the referring provider on the DMEPOS claim.string-
Referring_Provider_Last_Name_Organization_NameLast Name or Organization Name of the referring providerstring-
Referring_Provider_First_NameFirst Name of the Referring Providerstring-
Referring_Provider_Middle_InitialMiddle Initial of the Referring Providerstring-
Referring_Provider_CredentialsCredentials of the Referring Providerstring-
Referring_Provider_GenderGender of the Referring Providerstring-
Referring_Provider_EntityEntity Type of the Referring Provider, Type of entity reported in NPPES. Entity type identifies referring providers registered as individuals or the referring providers registered as organizations.string-
Referring_Provider_Street_1Street Address 1 of the Referring Provider, The first line of the referring provider’s street address, as reported in NPPES.string-
Referring_Provider_Street_2Street Address 2 of the Referring Provider, The second line of the referring provider’s street address, as reported in NPPES.string-
Referring_Provider_CityCity of the Referring Provider, The city where the referring provider is located, as reported in NPPESstring-
Referring_Provider_State_AbbreviationState Code of the Referring Provider, The state where the referring provider is located, as reported in NPPESstring-
Referring_Provider_Zip_CodeZip Code of the Referring Providerstring-
Referring_Provider_Country_CodeCountry Code of the Referring Providerstring-
Referring_Provider_Specialty_TypeSpecialty Type of the Referring Provider, Derived from the Medicare provider/supplier specialty code reported on all of the NPI's Part B non-institutional claims (DMEPOS and non-DMEPOS). For referring providers that have more than one Medicare specialty code reported on their claims, the Medicare specialty code associated with the largest number of services was used.string-
Referring_Provider_Specialty_Type_FlagA flag variable that indicates the source of the Referring Provider Type: Medicare Specialty Code description and Taxonomy Code Classification descriptionstring-
Number_of_SuppliersNumber of Suppliers Rendering DMEPOS Products/Servicesintegerlevel : Ratio
Number_of_Supplier_HCPCSNumber of Supplier HCPCSintegerlevel : Ratio
Number_of_Supplier_BeneficiariesNumber of Beneficiaries Associated with Supplier DMEPOS products/services ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiariesintegerlevel : Ratio
Number_of_Supplier_ClaimsNumber of Supplier DMEPOS Claims submitted by the supplier, reflecting products/services ordered by the referring provider. Aggregated records based on number_of_supplier_claims fewer than 11 are not included in the data file.integerlevel : Ratio
Number_of_Supplier_ServicesNumber of Supplier DMEPOS Services rendered by the supplier; note that the metrics used to count the number provided can vary from service to service.integerlevel : Ratio
Supplier_Submitted_ChargesThe total charges that suppliers submitted for all DMEPOS products/services ordered by the referring provider.numberlevel : Ratio
Supplier_Medicare_Allowed_AmountMedicare Allowed Amounts for DMEPOS. Medicare allowed amounts include the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.numberlevel : Ratio
Supplier_Medicare_Payment_AmountAmount that Medicare paid after deductible and coinsurance amounts have been deducted. It is done for all supplier's DMEPOS line item products/services ordered by the referring provider.numberlevel : Ratio
Durable_Medical_Equipment_Suppression_IndicatorA flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Number_of_Durable_Medical_Equipment_SuppliersNumber of suppliers rendering durable medical equipment products/services. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Durable_Medical_Equipment_HCPCSTotal number of unique durable medical equipment HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Durable_Medical_Equipment_BeneficiariesTotal number of unique beneficiaries associated with durable medical equipment claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of dataintegerlevel : Ratio
Number_of_Durable_Medical_Equipment_ClaimsTotal number of durable medical equipment claims submitted by suppliers, reflecting services ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Durable_Medical_Equipment_ServicesTotal durable medical equipment products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.integerlevel : Ratio
Durable_Medical_Equipment_Submitted_ChargesDurable Medical Equipment Submitted Charges, The total charges that suppliers submitted for all durable medical equipment products/services ordered by the referring provider. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.numberlevel : Ratio
Durable_Medical_Equipment_Medicare_Allowed_AmountThe Medicare allowed amount for all durable medical equipment products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Durable Medical Equipment Suppression Indicator regarding suppression of data.numberlevel : Ratio
Durable_Medical_Equipment_Medicare_Payment_AmountAmount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's durable medical equipment line item products/services ordered by the referring provider. A blank indicates the value is suppressed.numberlevel : Ratio
Prosthetic_And_Orthotic_Suppression_IndicatorA flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Number_of_Prosthetic_and_Orthotic_SuppliersNumber of suppliers rendering prosthetic and orthotic products/services. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Prosthetic_and_Orthotic_HCPCSTotal number of unique prosthetic and orthotic HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Prosthetic_and_Orthotic_BeneficiariesTotal number of unique beneficiaries associated with prosthetic and orthotic claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Prosthetic_and_Orthotic_ClaimsTotal number of prosthetic and orthotic claims submitted by suppliers, reflecting products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Prosthetic_and_Orthotic_ServicesTotal prosthetic and orthotic products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.integerlevel : Ratio
Prosthetic_and_Orthotic_Submitted_ChargesThe total charges that suppliers submitted for all prosthetic and orthotic products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.numberlevel : Ratio
Prosthetic_and_Orthotic_Medicare_Allowed_AmountThe Medicare allowed amount for all prosthetic and orthotic products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.numberlevel : Ratio
Prosthetic_and_Orthotic_Medicare_Payment_AmountAmount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier prosthetic and orthotic line item products/services ordered by the referring provider. A blank indicates the value is suppressed. See Prosthetic and Orthotic Suppression Indicator regarding suppression of data.numberlevel : Ratio
Drug_And_Nutritional_Suppression_IndicatorA flag indicating the reason the utilization, charge and payment subtotal information for Durable Medical Equipment is suppressed. Suppressed due to Number of Durable Medical Equipment Claims between 1 and 10. Counter suppressed because the claim count from at least one of the corresponding claim count categories (Number of Prosthetic and Orthotic Claims or Number of Drug and Nutritional Products Claims) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Number_of_Drug_and_Nutritional_Products_SuppliersNumber of suppliers rendering drug and nutritional products/services. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Drug_and_Nutritional_Products_HCPCSTotal number of unique drug and nutritional product. HCPCS codes billed by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Drug_and_Nutritional_Products_BeneficiariesTotal number of unique beneficiaries associated with drug and nutritional product claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of dataintegerlevel : Ratio
Number_of_Drug_and_Nutritional_Products_ClaimsTotal number of drug and nutritional product claims submitted by suppliers, reflecting services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.integerlevel : Ratio
Number_of_Drug_and_Nutritional_Products_ServicesTotal drug and nutritional products/services rendered by suppliers and ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.integerlevel : Rato
Drug_and_Nutritional_Products_Submitted_ChargesThe total charges that suppliers submitted for drug and nutritional products/services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.numberlevel : Ratio
Drug_and_Nutritional_Products_Medicare_Allowed_AmountThe Medicare allowed amount for drug and nutritional products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.numberlevel : Ratio
Drug_and_Nutritional_Products_Medicare_Payment_AmountAmount that Medicare paid suppliers after deductible and coinsurance amounts have been deducted for drug and nutritional line item products/services ordered by the referring provider. A blank indicates the value is suppressed. See Drug and Nutritional Suppression Indicator regarding suppression of data.numberlevel : Ratio
Referring_NPIReferring_Provider_Last_Name_Organization_NameReferring_Provider_First_NameReferring_Provider_Middle_InitialReferring_Provider_CredentialsReferring_Provider_GenderReferring_Provider_EntityReferring_Provider_Street_1Referring_Provider_Street_2Referring_Provider_CityReferring_Provider_State_AbbreviationReferring_Provider_Zip_CodeReferring_Provider_Country_CodeReferring_Provider_Specialty_TypeReferring_Provider_Specialty_Type_FlagNumber_of_SuppliersNumber_of_Supplier_HCPCSNumber_of_Supplier_BeneficiariesNumber_of_Supplier_ClaimsNumber_of_Supplier_ServicesSupplier_Submitted_ChargesSupplier_Medicare_Allowed_AmountSupplier_Medicare_Payment_AmountDurable_Medical_Equipment_Suppression_IndicatorNumber_of_Durable_Medical_Equipment_SuppliersNumber_of_Durable_Medical_Equipment_HCPCSNumber_of_Durable_Medical_Equipment_BeneficiariesNumber_of_Durable_Medical_Equipment_ClaimsNumber_of_Durable_Medical_Equipment_ServicesDurable_Medical_Equipment_Submitted_ChargesDurable_Medical_Equipment_Medicare_Allowed_AmountDurable_Medical_Equipment_Medicare_Payment_AmountProsthetic_And_Orthotic_Suppression_IndicatorNumber_of_Prosthetic_and_Orthotic_SuppliersNumber_of_Prosthetic_and_Orthotic_HCPCSNumber_of_Prosthetic_and_Orthotic_BeneficiariesNumber_of_Prosthetic_and_Orthotic_ClaimsNumber_of_Prosthetic_and_Orthotic_ServicesProsthetic_and_Orthotic_Submitted_ChargesProsthetic_and_Orthotic_Medicare_Allowed_AmountProsthetic_and_Orthotic_Medicare_Payment_AmountDrug_And_Nutritional_Suppression_IndicatorNumber_of_Drug_and_Nutritional_Products_SuppliersNumber_of_Drug_and_Nutritional_Products_HCPCSNumber_of_Drug_and_Nutritional_Products_BeneficiariesNumber_of_Drug_and_Nutritional_Products_ClaimsNumber_of_Drug_and_Nutritional_Products_ServicesDrug_and_Nutritional_Products_Submitted_ChargesDrug_and_Nutritional_Products_Medicare_Allowed_AmountDrug_and_Nutritional_Products_Medicare_Payment_Amount
1568531101WICKMARKRMIndividualLEE STCHARLOTTESVILLEVA229080001USPathologyMedicare Specialty Code description121314788171.692.25121314788171.692.25000000
1225142185MARCUSDANIELRDPMMIndividual254 ESSEX STSALEMMA1970USPodiatryMedicare Specialty Code description351463116163726.542682.53SuppressedSuppressed000
1154357077ALIMIRAMIndividual400 E 3RD STDULUTHMN558051951USInternal MedicineMedicare Specialty Code description3511121154843.51651.48Suppressed000Suppressed
1477596971NARAANDREWRMDMIndividual100 7TH AVECHARDONOH440247804USCardiologyMedicare Specialty Code description22111146761178.04926.86SuppressedSuppressed000
1992733323SHETHDEEPAKVMDMIndividual360 E 7TH ST#CUPLANDCA91786USUrologyMedicare Specialty Code description36121091889.421165.11830.16SuppressedSuppressed000
1194829663ARENAVICTORDPMMIndividual1269 WANTAGH AVEWANTAGHNY11793USPodiatryMedicare Specialty Code description5911275444.963622.442840SuppressedSuppressed000
1235132762TANLM.D.MIndividual2915 MADISON STMARIANNAFL324463449USUrologyMedicare Specialty Code description59132442719.052539.842004.5SuppressedSuppressed000
1972502326SHARNOFFDAVIDD.P.M.MIndividual9 COTS STSHELTONCT64843866USPodiatryMedicare Specialty Code description39112017231252.92990.28SuppressedSuppressed000
1982639076CHIHONGMDMIndividual200 2ND ST SWCATAWBANC28609USFamily PracticeMedicare Specialty Code description2311181779.99683.16542.32SuppressedSuppressed000
1336378173ELLENJOSEPHHMDMIndividual23 HACKETT BLVDALBANYNY122083436USUrologyMedicare Specialty Code description3411247731.4463.55367.16SuppressedSuppressed000