Frequently Asked Questions

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FAQ

By Topic: Medicare Provider Utilization and Payment Data Subtopic: Physician and Other Supplier


How does Medicare pay for services delivered by non-participating providers?
... (more)

Who pays the difference between what the provider charges and Medicare pays?
The provider has an ... (more)

Where can I find the standard payment by HCPCS code to compare to the data in the Physician and Other Suppl...
For standard paym... (more)

Why does the average Medicare payment amount differ across NPIs for the same HCPCS code in the Physician an...
The data in the Physician and Other Supplier PUF is aggregat... (more)

What is the source for the Physician and Other Supplier PUF?
The data for the Physician and Other ... (more)

My physician has two practice locations.  Can I use the Physician and Other Supplier PUF to figure out...
No, the Physician an... (more)

Payments for services often include different components that vary by place of service, which of these comp...
The average_Medicare... (more)

Is the allowed amount in the Physician and Other Supplier PUF the amount that a Medicare beneficiary actual...
No. This figure incl... (more)

Can I access patient demographic information for any of the Medicare Provider Utilization and Payment Data ...
Patient demographic information and health characteristics a... (more)

The documentation for the Physician and Other Supplier PUF indicates that for the "line_srvc_cnt" the metri...
Service counts may be calculated in different ways. For most... (more)

What do I do if I think I’ve identified fraud in the Physician and Other Supplier PUF?
CMS is committed ... (more)

If I publish findings from the Medicare Provider Utilization and Payment Data in medical journals do I need...
No, this data is ... (more)

How did CMS calculate the values in the Physician and Other Supplier PUF?
The spending and uti... (more)

Does the Physician and Other Supplier PUF include non-physician practitioners, such as nurse practitioners?
Yes, you can filter ... (more)

Does anyone actually pay the submitted charges in the Physician and Other Supplier PUF?
In the private marke... (more)

What is the population included in the Physician and Other Supplier PUF?
The Physician and Ot... (more)

Do the average submitted charges in the Physician and Other Supplier PUF for services delivered in a facili...
When services are delivered in a facility setting, Medicare ... (more)

In the Physician and Other Supplier PUF what is the definition for the bene_day_srvc_cnt variable?
The bene_day_srvc_cn... (more)

Can I use the data in the Physician and Other Supplier PUF to create graphics, applications, or tools?
Yes, this data is pu... (more)

Can I link the Physician and Other Supplier PUF to other data CMS releases or other public data?
When linking data fr... (more)

For each HCPCS code (particularly the ones that start with J for drugs), does the variable average_submitte...
The average submitted charge is derived ... (more)

Do Medicare payments associated with drug services include payment of the drug and injection of the drug in...
Payment for part B d... (more)

In the Physician and Other Supplier PUF how are averages calculated for the average_Medicare_allowed_amt, a...
The average payment ... (more)

Don’t physicians have a privacy interest in the data in the Physician and Other Supplier PUF?
Prior to deciding... (more)

In the Physician and Other Supplier PUF what is the definition for the "line_srvc_cnt" variable?
The "line_srvc_cnt" reflects the number of services provided... (more)

Does the Physician and Other Supplier PUF contain information for beneficiaries in Medicare Advantage or Me...
... (more)

When I open the Physician and Other Supplier PUF in Excel, I get an error, why?
The Physician and Other Supplier PUF contains just over 9 million lines of data.... (more)

Does the average Medicare payment amount field in the Physician and Other Supplier PUF need to be adjusted?
No, the average_Medi... (more)

How are you protecting beneficiary privacy in the Physician and Other Supplier PUF?
CMS takes beneficiar... (more)

Why hasn’t CMS included information on quality in the Physician and Other Supplier PUF?
CMS has started p... (more)