Medicare Provider Utilization and Payment Data

This dataset is prepared by CMS and contains information on services and procedures provided to Medicare Part B beneficiaries by physicians. The data contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. See the FAQ to find out more.

Medicare_Provider_Util_Payment_PUF_CY2013.txt 2.2 GMB, 9,287,877 rows, 28 columns

COLUMNS

• AVERAGE_MEDICARE_ALLOWED_AMT
• AVERAGE_MEDICARE_PAYMENT_AMT
• AVERAGE_SUBMITTED_CHRG_AMT
• BENE_DAY_SRVC_CNT
• BENE_UNIQUE_CNT
• HCPCS_CODE
• HCPCS_DESCRIPTION
• HCPCS_DRUG_INDICATOR
• LINE_SRVC_CNT: for most physicians this reflects the count of events, see FAQ
• MEDICARE_PARTICIPATION_INDICATOR

About the provider:

• NPI
• NPPES_CREDENTIALS
• NPPES_ENTITY_CODE': I (Individual) or O (Organization) see here
• NPPES_PROVIDER_CITY
• NPPES_PROVIDER_COUNTRY
• NPPES_PROVIDER_FIRST_NAME
• NPPES_PROVIDER_GENDER
• NPPES_PROVIDER_LAST_ORG_NAME
• NPPES_PROVIDER_MI
• NPPES_PROVIDER_STATE
• NPPES_PROVIDER_STREET1
• NPPES_PROVIDER_STREET2
• NPPES_PROVIDER_ZIP
• PROVIDER_TYPE
• PLACE_OF_SERVICE: O or F
• average_Medicare_payment_amt: represents the average amount that Medicare paid after deductible and coinsurance amounts have been deducted for the given line item service. For services delivered in a non-facility setting, such as a physician’s office (place_of_service =“O”), the Physician and Other Supplier PUF represents the complete payment for the service or the global payment. For services delivered in a facility (place_of_service =“F”), the data in the Physician and Other Supplier PUF only represents the physician’s professional fee and does not include any payments to the facility.
• STDEV_MEDICARE_ALLOWED_AMT
• STDEV_MEDICARE_PAYMENT_AMT
• STDEV_SUBMITTED_CHRG_AMT

The triplet (NPI, HCPCS, PLACE_OF_SERVICE) is the identifier. We will need a classifier for HCPCS codes.

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