Frequently Asked Questions

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FAQ

Does the average Medicare payment amount field in the Physician and Other Supplier PUF need to be adjusted?

No, the 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.  However, please note that Medicare pays differently when services are provided in a facility setting versus a freestanding physicians’ office (or other non-facility setting). When services are delivered in a facility setting, Medicare makes two payments, one for the physician’s professional fee and one for the facility. 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 the facility payment. On the other hand, 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.

(FAQ9916)

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