Package 'cms'

cms: Tools for Calculating CMS Medicare Reimbursement

Description

Uses the CMS API to provide useRs databases containing yearly Medicare reimbursement rates in the United States. Data can be acquired for the entire United States or only for specific localities. Currently, support is only provided for the Medicare Physician Fee Schedule (MPFS), but support will be expanded for other CMS databases in future versions.

---

Access Medicare Physician Fee Schedule

Description

Use the CMS API to download the MPFS database for any year between 2014 and 2020, inclusive.

Usage

get_mpfs(year, storage_path, keep_downloads = TRUE, locality)

Arguments

year	integer (min = 14; max = 20) indicating MPFS database year
storage_path	path to storing downloaded files (temporarily if 'keep_downloads' equals 'FALSE')
keep_downloads	if 'TRUE', stores compressed CMS data to prevent re-downloading; if 'FALSE', deletes intermediate data after loading into R
locality	7-digit HCFS identification number; if not specified, will return entire MPFS database (all localities)

Value

MPFS database for respective year and localities (data frame)

Examples

## Not run: 
# get entire MPFS database for 2020
mpfs20 <- get_mpfs(20, storage_path = 'storage', keep_downloads = TRUE)

# get 2019 MPFS database only for carrier 15202 and locality 00
mpfs19 <- get_mpfs(19, storage_path = 'storage', locality = '1520200')

## End(Not run)

---

Locality dictionary for 2020 Physician Fee Schedule

Description

Asterisk indicates that payment locality is serviced by two carriers.

Usage

locality_dict

Format

data frame with 113 rows and 5 columns:

Carrier Number

character; 5-digit carrier ID

Locality

character; 2-digit locality ID

State

character; uppercase, full U.S. state name

Fee Schedule Area

character; description of fee schedule area

Counties

character; counties included in Fee Schedule Area

Source

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Locality

---

2020 Physician Fee Schedule, Ohio

Description

2020 Physician Fee Schedule, Ohio

Usage

mpfs20_oh

Format

data frame with 8994 rows and 15 columns:

Year

numeric; 4-digit year

Carrier Number

character; 5-digit carrier ID

Locality

character; 2-digit locality ID

HCPCS Code

character; CPT or level 2 HCPCS code for procedure

Modifier

factor; payment schedule modifier

PCTC Indicator

character; Professional Component/Technical Component Indicator

Status Code

character; Medicare status code (e.g. A = Active code)

Multiple Surgery Indicator

character; indicator of payment adjustment rules for multiple procedures

50% Therapy Reduction Amount (non-institutional)

numeric; multiple procedure therapy reduction amount (non-institutional)

50% Therapy Reduction Amount (institutional)

numeric; multiple procedure therapy reduction amount (institutional)

OPPS Indicator

character; indicator as to whether Outpatient Prospective Payment System applies

Facility Fee

numeric; reimbursement for procedure performed in a facility setting

Non-Facility Fee

numeric; reimbursement for procedure performed in a non-facility setting

OPPS Facility Fee

numeric; reimbursement for procedure performed in a facility setting if OPPS applies

OPPS Non-Facility Fee

numeric; reimbursement for procedure performed in a non-facility setting if OPPS applies

Source

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-National-Payment-Amount-File

---