Medicare Professional Fee Data File

Optum


Optum360® Medicare Professional Fee Data Files allow you to access Medicare fee schedules released by CMS and supplement that data with proprietary data add-ons.

Valuable data that is difficult to collect and find

  • No more struggling to obtain locality- and carrier-specific prices
  • Items and services listed in one consistent data format
  • Data available via download
  • Access data updates throughout the year as they become available

All data sets are available as .txt files, available to download from the web. Data sets are available via the web services team. Call for pricing. Custom formats may require custom pricing.

These files allow you to develop a complete Medicare-based fee system for professional and ASC services. The data is single locality or all localities and can easily be imported for maximum convenience. Seek custom file layouts, calculations, or Optum360® proprietary data enhancements not available elsewhere for fee schedule development and payment system maintenance. Our team works with you to ensure that the data meets your requirements.

Customize your Medicare Professional Fee Data based on your needs with these available data sets:

  • Set 1 National RBRVS Medicare Values
  • Set 2 Locality Specific Relative Values (Single Locality or All)
  • Set 3 Locality Specific Medicare Physician Fees (Single Locality or All)
  • Set 4 Clinical Lab Fee Schedule (Single Locality or All)
  • Set 5 Locality Medicare Average Anesthesia Fees (Single Locality or All)
  • Set 6 Medicare Psychologist and Clinical Social (Single Locality or All)
  • Set 7 Medicare HCPCS (DMEPOS) Fees (Single State or All)
  • Set 8 Medicare ASC Rates (Single State or All)
  • Set 10 ZIP Code to Medicare Locality Crosswalk
  • Set 11 National Medicare Physician Fee Schedule (MPFS)
  • Set 12 Medicare Anesthesia Relative Values and Conversion Factors
  • Set 13 Medicare Ambulance Fee (Single Carrier or All)
  • Set 14: Medicare Place of Service (POS) Code File
  • Set A Optum360 Proprietary Gap Values for RBRVS
  • Set B Anesthesia Base Units for Surgical CPT® Codes
  • Set C Medicare Single Drug Pricer Drug Pricing 

 

CPT is a registered trademark of the American Medical Association.

 

 

Nichole VanHorn, CPC, CCS-P

Ms. VanHorn has more than 20 years of experience in the health care profession. Her areas of expertise include CPT® and ICD-10-CM coding in multiple specialties, auditing, and education. Most recently she served as Clinical Auditor for a multi-specialty group. Ms. VanHorn was responsible for the oversight of the physician coding and education section of the Corporate Compliance Program. She has been an active member of her local American Academy of Professional Coders (AAPC) chapter for several years and has also served as an officer.

CPT is a registered trademark of the American Medical Association.