Data Files & Web Services

Optum360 data files and web services solutions supply you with rigorously reviewed data, valuable proprietary information, and frequent updates to maximize your systems’ capabilities. Choose solutions that bring you updated codes throughout the year or simply choose one of our standard data file solutions for one-time delivery. And we offer add-on data elements to enhance your coding systems.




Browse Data Files for:


Core Coding

ICD-10 Base Data File
Optum360® proprietary descriptions, 35 byte and 48 byte. Also included is the CMS full description. Flags displaying the code as complete or incomplete and status (new, changed, and deleted) are also provided. Learn More
ICD-9-CM Data File, Volumes 1 & 3
Complete with clinically reviewed and abbreviated code sets and proprietary add-on information, you’ll have access to essential coding and reimbursement data for the ICD-9-CM code set in an updateable, easy-to-use format. Learn More
Optum360 Current Procedural Codes with RVUs Subscription Data File
Complete with clinically reviewed and abbreviated code sets and proprietary add-on information, you’ll have access to essential coding and reimbursement data for the CPT® code set in an updatable, easy-to-use format. Learn More
HCPCS Subscription Data File
Complete with clinically reviewed and abbreviated code sets and proprietary add-on information, you’ll have access to essential coding and reimbursement data for the HCPCS code set in an updatable, easy-to-use format. Learn More
HCPCS Dental Data File
Complete with clinically reviewed and abbreviated code sets. HCPCS Level II alphanumerical codes that begin with the letter D and are used to report dental services and procedures. Current Dental Terminology (CDT) codes will be used to identify all dental procedures. Learn More
DRG Subscription Data File
Complete with clinically reviewed and abbreviated code sets and proprietary add-on information, you’ll have access to essential coding and reimbursement data for the DRG code set in an updateable, easy-to-use format. Learn More

Workers' Compensation

Workers’ Compensation Fee Schedules Data Files
Optum360 is the exclusive publisher of the official Workers’ Compensation Fee Schedule for several states. Health care professionals and payers need to reference this information to determine correct reimbursements. Although specific data varies state by state, these comprehensive references generally include state-specific rules and guidelines, fees or RVUs, CPT® codes and applicable state-specific codes for services rendered. State Fee Schedule Plus module is also available, a database of current state fee schedule data arrayed in a consistent format. Request A Consultation

Relative Values

Relative Values for Physicians
A complete relative value system established by national surveys of physicians in all specialties conducted by Relative Value Studies, Inc. Learn More
Relative Values for Dentists
A relative value system established by national surveys of physicians and dentists conducted by Relative Value Studies, Inc. Learn More
The Complete RBRVS
An RBRVS fee schedule with gap values created by Relative Value Studies, Inc. The Medicare physician fee schedule (MPFS) is used to set physician fees for Medicare and many commercial fee schedules. Learn More
The Essential RBRVS
Provides all the codes valued by CMS, as well as relative values for many codes not valued for Medicare. The RBRVS for the Medicare physician fee schedule (MPFS) is used to set physician fees by Medicare and many commercial payers. However, the RBRVS does not provide a complete schedule. Codes not valued for Medicare, within the MPFS, are referred to as gap codes. The Essential RBRVS provides Medicare values and gap values to enable you to develop a more complete fee schedule. Learn More

Billing

Revenue Codes Data File
an updateable data file that can help you meet billing requirements and achieve accurate chargemaster set-up, billing and claims processing. Access a year’s worth of code changes and updates, all valid CPT® and HCPCS Level II codes and the corresponding revenue codes that are appropriate for the type of bill. Learn More
The UB-04 Data File
a dependable source of electronic medical billing content. It includes the complete UB-04 code set, including each of 81 form locators (FLs), all revenue codes and descriptions, and other billing code sets, such as type-of-bill codes; condition, occurrence, and value codes; admission source and patient status codes, and more. This data file may be used to power medical coding, billing and other decision support tools. Learn More
The National Correct Coding Initiative Edits Data File
Provides the complete Official National Correct Coding Initiative (NCCI) edits for robust unbundling data every quarter. Learn More
Hospital Outpatient NCCI Data File
Official Facility Outpatient Correct Coding Initiative edits provide you with robust unbundling data every quarter. With the Hospital OPPS NCCI Edits Data File you can keep current with frequent changes to unbundling edits. Learn More
Medical Necessity (LCD & NCD) Carrier/Contractor Specific Data File
Check procedures for Medicare coverage instructions and medical necessity edits. Request A Consultation

Cross Coding

Cross Coder Data Files
Simplify and speed coding for services. The Cross Coder Data Files provide essential links from CPT® codes to the appropriate ICD-10-CM and HCPCS Level II codes. Request A Consultation
Cross Coder: CPT® to ICD-10-PCS Crosswalk Data File
This data file contains all crosswalks available between CPT® and ICD-10-PCS. Learn More
Cross Coder: ICD-10-PCS to CPT® Crosswalk Data File
This data file contains all crosswalks available between ICD-10-PCS and CPT®. Learn More
Revenue Code Crosswalk
An annual or updateable data file that can help you meet billing requirements and achieve accurate chargemaster set-up, billing and claims processing. Access a year’s worth of code changes and updates, all valid CPT® and HCPCS Level II codes and the corresponding revenue codes that are appropriate for the type of bill. Learn More
Revenue Code Crosswalk Plus
Data file features the content from the Revenue Code Crosswalk data file and includes commercial code combinations in addition to Medicare. Learn More

Medicare Pricing

Optum360 Medicare Professional Fee Data Files
Provides access to all Medicare fee schedules released by CMS. Learn More
Optum360 Medicare Carrier Pricing Data
Complete with clinically reviewed and abbreviated code sets and proprietary add-on information, you’ll have access to essential coding and reimbursement data for the CPT® and HCPCS code sets in an updateable, easy-to-use format. Request A Consultation

Custom

Custom Data Services
Optum360 can create custom data to your specifications and will work with you to create a custom extract to your unique specifications. Please call us at 800-464-3649, option 1 for a consultation.
ICD-10 for TriZetto QicLink Data File
ICD-10 for TriZetto QicLink contains ICD-10 code set descriptions and specifically formated for TriZetto QicLink. Please call us at 800-464-3649, option 1 for a consultation.
MACRA Data File
Get expert direction on the new Quality Payment Program (QPP) mandated under MACRA. Please call us at 800-464-3649, option 1 for a consultation.

Fee Analyzer

Customized Fee Analyzer
Provides physicians with percentiles of physician charge data for their geographic area and the CPT® codes most frequently used in their specialty. Learn More
Dental Customized Fee Analyzer
Provides dentists and oral surgeons with a customized report for a specific geographic area and the CPT® and CDT codes most frequently used in a dental and/or OMS practice. Learn More
HCPCS Fee Analyzer
A customized report that includes four percentiles of national charge data as well as locality-specific Medicare allowables for HCPCS codes. Learn More

Optum360 Web Services are also offered — Watch the video.

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