MRI and Ultrasound and Medicare allowance NY – a sample from one doctor

mri and Ultra medicare allowance NY.JPG

Connie’s comments: There are higher number of scans for leg joint and abdomen from sample with Medicare in NY. The most expensive scans are MRI scan of abdomen before and after contrast, CT scan of abdomen and pelvis before and after contrast, and MRCI scan of leg.

https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Provider-Utilization-and-Payment-Data-Phy/sk9b-znav

Physician and Other Supplier Data CY 2015

The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

While the Physician and Other Supplier PUF has a wealth of information on payment and utilization for Medicare Part B services, the dataset has a number of limitations.  Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries.  In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations.  However, we have provided average beneficiary risk scores on the “Medicare Physician and Other Supplier Aggregate Table” (i.e., one record per NPI) to provide information on the health status of the beneficiaries the providers serve. For additional limitations, please review the methodology document available below.

Data are available in two formats:

  • An online interactive dataset (allows users to sort and filter data directly without downloading).
  • Tab delimited file format (requires importing into database or statistical software; SAS® read-in language is included in the download ZIP package)

CMS has also created two types of summary tables: 1) aggregated information by physician or other supplier and 2) aggregated information by State and HCPCS code.   A detailed methodology document can be found in the Downloads section below which contains important information regarding the limitations of data usage.

Detailed Data: 

Interactive Dataset: Medicare Physician and Other Supplier PUF, CY2015, Interactive Dataset

Downloadable Tab Delimited Format: Medicare Physician and Other Supplier PUF, CY2015, Tab Delimited format
[Note: This Compressed ZIP package contains the tab delimited data file (Medicare_Provider_Util_Payment_PUF_CY2015.txt) which is 2.0 GB uncompressed and contains more than 10 million records, thus importing this file into Microsoft Excel will result in an incomplete loading of data.  Use of database or statistical software is required; a SAS® read-in statement is supplied.  Additionally, this ZIP package contains the following supporting documents: CMS_AMA_CPT_license_agreement.pdf, and Medicare-Physician-and-Other-Supplier-PUF-SAS-Infile.sas]

Provider Summary Table:

Interactive Dataset: Medicare Physician and Other Supplier Aggregate table, CY2015, Interactive Dataset

Downloadable Tab Delimited Format: Medicare Physician and Other Supplier Aggregate table, CY2015, Tab Delimited format

Procedure Summary Tables:

Medicare National/HCPCS Aggregate table, CY2015, Microsoft Excel (.xlsx)
Medicare State/HCPCS Aggregate table, CY2015, Microsoft Excel (.xlsx)

Additional information can be found at our Frequently Asked Questions page.

Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.

To receive email notifications, please sign up for the Medicare Provider Data GovDelivery subscription here.

  • Page last Modified: 06/15/2017 1:21 PM

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