MPFS - Medicare Physician Fee Schedule
Physician and practitioner payment rates by HCPCS and locality, including facility and non-facility amounts.
Select MPFS - Medicare Physician Fee Schedule in the Medicare dataset picker to work with this data. There is one row per HCPCS code, modifier, and MAC locality.
Using Facility Amount for an office service overstates percent of Medicare. Place-of-service 11 (office) claims benchmark against Non-Facility Amount.
Fields
HCPCS_Code
HCPCS Code
Healthcare Common Procedure Coding System code. e.g. 0001F
Modifier
Modifier
Optional two-character CPT/HCPCS pricing modifier that splits a code into separate rows. e.g. TC
Status_Code
Status Code
Procedure status indicator determining Medicare coverage and payment status. A is active and priced; statuses such as C, B, I, and N carry no usable fee-schedule price. e.g. I
MAC
MAC
Medicare Administrative Contractor identifier code. There are 12 MACs across the country. e.g. 01182
Locality
Locality
Geographic payment locality code under the MAC. There are 48 unique locality codes across 112 localities. e.g. 18
Mac_Locality
Mac Locality
Combined MAC and locality identifier code, stored as a 7-digit zero-padded string. This is the most specific MPFS factor identifier used to alter rates. e.g. 0230299
Facility_Amount
Facility Amount
Medicare allowed charge when services are performed in a facility setting like a hospital or ASC. e.g. $4,412.86
Non_Facility_Amount
Non-Facility Amount
Medicare allowed charge when services are performed in a non-facility setting like a physician's office. e.g. $4,154.90
State
State
State corresponding to the MAC locality. e.g. California
County
County
County or list of counties included in the MAC locality area. e.g. NAPA
Working with modifiers
Modifiers in the MPFS adjust the base rates. Other modifiers are applied on claims and adjust payment separately, so match on code plus modifier rather than code alone.
Working with MAC localities
Mac_Locality is the zero-padded concatenation of MAC and Locality, and the leading zero is significant — left-pad 6-digit external codes before filtering on an exact value. 0000000 is the National row and is not a default to fall back to.
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