Medicare Outpatient Data

Data dictionary fields for Medicare outpatient data in Payerset.

Outpatient Data

Field Name	Friendly Name	Description / Sample Value
HCPCS Code	HCPCS Procedure Code	Healthcare Common Procedure Coding System code. e.g. 0275T
Modifier	HCPCS Modifier	Optional two-character modifier. e.g. "" (empty if none)
Short Description	Service Short Description	Brief description of the procedure. e.g. Perq lamot/lam lumbar
Mac Locality	MAC Locality Code	Medicare Administrative Contractor locality code. e.g. 111205
Locality County	County	County that corresponds with Mac Locality
Locality State	State	State that corresponds with Mac Locality
Non-Facility Price	Non-Facility Price	Allowed charge in a non-facility setting. e.g. "$0.00"
Facility Price	Facility Price	Allowed charge in a facility setting. e.g. "$0.00"
Non-Facility Limiting Charge	Non-Facility Limiting Charge	Payment limit for non-facility. e.g. "$0.00"
Facility Limiting Charge	Facility Limiting Charge	Payment limit for facility. e.g. "$0.00"
GPCI Work	Work GPCI Factor	Geographic practice cost index for work. e.g. 1.088
GPCI PE	Practice Exp. GPCI Factor	Geographic practice cost index for practice expense. e.g. 1.419
GPCI MP	Malpractice GPCI Factor	Geographic malpractice cost index. e.g. 0.445
Proc Stat	Procedure Status	Status indicator (e.g. R=revised). e.g. "R"
Work RVU	Work RVU	Relative value unit for physician work. e.g. 0.00
NA Flag for Trans Non-FAC PE RVU	Flag: Transitional Non-Facility PE RVU Missing	"NA" if no transitional practice-expense RVU available
Transitioned Non-FAC PE RVU	Transitional Non-Facility PE RVU	Transitional practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Fully IMP Non-FAC PE RVU	Flag: Fully Implemented Non-FAC PE RVU Missing	"NA" if no fully implemented practice-expense RVU available
Fully Implemented Non-FAC PE RVU	Fully Impl. Non-Facility PE RVU	Final practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Trans Facility PE RVU	Flag: Transitional Facility PE RVU Missing	"NA" if no transitional practice-expense RVU for facility available
Transitioned Facility PE RVU	Transitional Facility PE RVU	Transitional practice-expense RVU, facility. e.g. 0.00
NA Flag for Fully IMP FAC PE RVU	Flag: Fully Implemented Facility PE RVU Missing	"NA" if no fully implemented practice-expense RVU for facility available
Fully Implemented Facility PE RVU	Fully Impl. Facility PE RVU	Final practice-expense RVU, facility. e.g. 0.00
MP RVU	Malpractice RVU	Relative value unit for malpractice. e.g. 0.00
Transitioned Non-FAC Total	Transitional Non-Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(non-facility). e.g. 0.00
Transitioned Facility Total	Transitional Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(facility). e.g. 0.00
Fully Implemented Non-Fac Total	Fully Impl. Non-Facility Total RVU	Sum of RVUs (work+PE+MP) final, non-facility. e.g. 0.00
Fully Implemented Facility Total	Fully Impl. Facility Total RVU	Sum of RVUs (work+PE+MP) final, facility. e.g. 0.00
PCTC	Multiple-Procedure Indicator	Indicator for multiple-procedure payment reduction. e.g. "YYY"
Global	Global Surgical Indicator	Global surgery period indicator (0=no global). e.g. 0
Pre Op	Pre-Operative RVU	RVU for pre-operative period. e.g. 0.00
Intra Op	Intra-Operative RVU	RVU for intra-operative period. e.g. 0.00
Post Op	Post-Operative RVU	RVU for post-operative period. e.g. 0.00
Mult Surg	Multiple Surgery RVU	RVU adjustment for multiple surgeries. e.g. 0.00
Bilt Surg	Bilateral Surgery RVU	RVU adjustment for bilateral procedures. e.g. 0.00
Asst Surg	Assistant Surgeon RVU	RVU for assistant surgeon. e.g. 0.00
Co Surg	Co-Surgeon RVU	RVU for co-surgeon. e.g. 0.00
Team Surg	Team Surgery RVU	RVU for team surgery. e.g. 0.00
Phys Supv	Physician Supervision RVU	RVU for physician supervision. e.g. 0.00
Endobase	Endoscopic Base RVU Indicator	Indicator if code is endoscopic base. e.g. ""
Conv Fact	Conversion Factor	Dollar-to-RVU conversion factor. e.g. 32.3465
Not Used for Medicare	Excluded from Medicare	Flag if code is not payable by Medicare. e.g. ""
Diag Imaging Family Ind	Diagnostic Imaging Family Indicator	Family group code. e.g. 99
Opps Non-Facility Payment Amount	OPPS Non-Facility Payment	Payment amount under OPPS non-facility. e.g. "NA"
Opps Facility Payment Amount	OPPS Facility Payment	Payment amount under OPPS facility. e.g. "NA"
Non-Fac PE Used For Opps PMT AMT	Non-Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS non-facility calculation. e.g. 0.0
Facility PE Used For Opps PMT AMT	Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS facility calculation. e.g. 0.0
Malpractice Used For Opps PMT AMT	Malpractice PE Weight for OPPS Payment	Malpractice index used in OPPS payment calculation. e.g. 0.0