Frequently Asked Questions

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FAQ

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


Where can I find the standard payment by HCPCS code to compare to the data in the Physician and Other Suppl...
For standard payment and allowed amount by CPT/HCPCS code, please refer to: Physician Fee Sched... (more)

How does Medicare pay for services delivered by non-participating providers?
For services and procedures performed by non-participating fee-for service providers (i.e., those providers who opt out ... (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 aggregated to the following: the NPI for the performing provider, th... (more)

What is the source for the Physician and Other Supplier PUF?
The primary data source for these data is CMS’s National Claims History (NCH) Standard Analytic Files (SAFs) which in... (more)

Payments for services often include different components that vary by place of service, which of these comp...
The average_Medicare_payment_amt represents the average amount that Medicare paid after deductible and coinsurance amoun... (more)

If I publish findings from the Medicare Provider Utilization and Payment Data in medical journals do I need...
No, this data is public information and users are free to use the data in publications. Please remember that CPT codes, ... (more)

The documentation for the Physician and Other Supplier PUF indicates that for the line_srvc_cnt the metrics...
Service counts may be calculated in different ways. For most physician services, the line_srvc_cnt reflects the actual c... (more)

Does anyone actually pay the submitted charges in the Physician and Other Supplier PUF?
In the private market, patients with comprehensive coverage often do not pay full charges because insurance companies ne... (more)

How did CMS calculate the values in the Physician and Other Supplier PUF?
The spending and utilization data in the Physician and Other Supplier PUF is aggregated to the following: the NPI for th... (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 makes two payments, one for the physician’s professional fee... (more)

My physician has two practice locations.  Can I use the Physician and Other Supplier PUF to figure out...
No, the Physician and Other Supplier PUF does not allow users to distinguish between services delivered at different pra... (more)

In the Physician and Other Supplier PUF what is the definition for the bene_day_srvc_cnt variable?
The bene_day_srvc_cnt is the number of distinct Medicare beneficiary/per day services. Since a given beneficiary may rec... (more)

Is the allowed amount in the Physician and Other Supplier PUF the amount that a Medicare beneficiary actual...
No. This figure includes the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is respon... (more)

Can I use the data in the Physician and Other Supplier PUF to create graphics, applications, or tools?
Yes, this data is public information.  Please remember that CPT codes (numeric HCPCS codes), descriptions and other... (more)

What do I do if I think I’ve identified fraud in the Physician and Other Supplier PUF?
CMS is committed to the prevention and detection of fraud and abuse in the Medicare program and partners with numerou... (more)

What is the population included in the Physician and Other Supplier PUF?
The Physician and Other Supplier PUF includes data for providers that had a valid NPI and submitted Medicare Part B non-... (more)

Do Medicare payments associated with drug services include payment of the drug and injection of the drug in...
Payment for part B drugs does not include payment for services such as injections that may be necessary to administer th... (more)

In the Physician and Other Supplier PUF how are averages calculated for the average_Medicare_allowed_amt, a...
The average payment and charge variables reflect the total payments or charges for a given HCPCS code/place of service d... (more)

Why have you only listed the short descriptions for the HCPCS codes in the Physician and Other Supplier PUF?
Numeric HCPCS codes (Level I codes) consist of the AMA’s CPT codes, while alpha-numeric codes (Level II codes) are devel... (more)

Does the Physician and Other Supplier PUF include non-physician practitioners, such as nurse practitioners?
Yes, you can filter on the provider_type variable to identify specific provider types such as nurse practitioners.... (more)

Can I access patient demographic information for any of the Medicare Provider Utilization and Payment Data ...
CMS has not released patient demographic information associated with any of the Medicare Provider Utilization and Paymen... (more)

Don’t physicians have a privacy interest in the data in the Physician and Other Supplier PUF?
Prior to deciding to release physician payment information, as required by the FOIA and case law interpreting FOIA Ex... (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. As a result, this file is too large to ... (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 and is based off the units count from the claim lines.... (more)

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 a... (more)

Why hasn’t CMS included information on quality in the Physician and Other Supplier PUF?
CMS has started publishing quality of care ratings for Group Practices on Physician Compare at ... (more)

Can I link the Physician and Other Supplier PUF to other data CMS releases or other public data?
When linking data from this file to other public datasets, please be aware of the particular Medicare populations includ... (more)

How are you protecting beneficiary privacy in the Physician and Other Supplier PUF?
CMS takes beneficiary privacy very seriously, and will not release any personally identifiable information about benefic... (more)

Does the Physician and Other Supplier PUF contain information for beneficiaries in Medicare Advantage? ...
No, the Physician and Other Supplier PUF only includes claims submitted under the Medicare fee-for-service program. ... (more)