Wednesday, September 20, 2017

Quick Links to 3 CMS Part B Utilization Sources


(A) PART B CARRIER SUMMARY DATA FILE (EG STATE LEVEL DATA)
CMS publishes a web page called  Physician Fee Schedule Carrier Specific Files.   These publish  CPT codes, total uses, and total payment for every state.  Technically, every MAC district - for example, California has 2 districts to add up to one state.   Typically, this appears about in November for the prior calendar year.  For example, you would expect CY2016 in November 2017.   The web page is here:

    

(B) PROVIDER SPECIFIC DATA (PHYSICIANS & LABS)
On a longer delay, CMS publishes an amazing file of all CPT code use by all physicians and labs.   (For example, Dr. John Smith in Peterville, FL billed code 99212 for 835 times).  This is on an 18 month delay.  So CY2016 data will appear in May or June of 2018.   It covers Part B physicians & labs; it does not include Part B DME or IDTF.   The web page is here:



(C)  NATIONAL UTILIZATION BY CPT CODE
CMS also publishes a file called National Summary Data File (Previosly Known as BESS).  This is the USA wide part B utilization so it is only useful for a very high birds eye view.  Similar nationwide data also appears in files as part of annual PFS rulemaking.



An extensive set of CMS datasources is found here:
https://www.cms.gov/center/freedom-of-information-act/index.html

As indicated by the A, B, C links above, the home page for those data sources is:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html


Note/Warning:
Do not confuse the Part B Carrier Summary Data File (linked [A] above) with the Part B Carrier Specific Files, which is just PFS fee schedule and local pricing level information (here).

No comments:

Post a Comment