Healthcare Statistics

Below is a list of the products we offer broken down by record groups and data types. Click on the headings below to learn more about the products available. Click on the product name for a description and a link to our store.

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Carrier Part B Expenditures
- National by MTUS Indicator by HCPCS
  - PTBTBL01
    Medicare Part B Expenditures, Nationally by MTUS Indicator by HCPCS Code for calendar years 1996-2001: Elements contained in this table: Total Services, Allowed Services, MTUS, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges. Price given is per year.
    Media: Diskette or Compact Disc
    File Format: ASCII, Comma Delimited, Excel
- Nationally by Specialty
  - PTBTBL02
    Medicare Part B Expenditures, Nationally by Specialty Code for calendar years 1996-2001: Elements contained in this table: Total Services, Allowed Services, MTUS, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges. Price given is per year.
    All years sold together at a discount when you choose to view them online.
- Nationally by MTUS Indicator by HCPC
  - PTBTBL03
    Medicare Part B Expenditures, by Carrier by MTUS indicator by HCPCS for calendar years 1996-2001: Elements contained in this table: Total Services, Allowed Services, MTUS, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges. Prices given are per year, per Carrier. Data is available on compact disc in ASCII or Comma Delimited format.
    Not sure which carrier you need? Choose from our list.
- Nationally by BETOS
  - PTBTBL06
    Medicare Part B Expenditures, Nationally by BETOS Code for calendar years 1996-2001: Elements contained in this table: Allowed Services, Allowed Charges, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges.
    Media Type: Diskette or Compact Disc
    File Format: Excel, ASCII or Comma Delimited
- By Carrier by BETOS Code
  - PTBTBL07
    Medicare Part B Expenditures, by Carrier by BETOS Code for calendar years 1996-2001: Elements contained in this table: Allowed Services, Allowed Charges, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges.
    Price given is per year of data.
    Data will be delivered on compact disc in Excel, ASCII or Comma Delimited format.
- By Carrier by Specialty
  - PTBTBL10
    Medicare Part B Expenditures, by Carrier by Specialty for calendar years 1996-2001: Elements contained in this table: Allowed Services, Allowed Charges, Denied Services, Assigned Services, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges.
    Price given is per year of data.
    The data is in ASCII, Comma Delimited or Excel format on compact disc.
- Nationally by Specialty, by HCPCS Code, by Modifier #1
  - PTBTBL12
    Medicare Part B Expenditures, Nationally by Specialty Code by HCPCS Code by Modifier #1 by Carrier for calendar years 1996-2001: Elements contained in this table: Total Services, Allowed Services, MTUS, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, and Payment Amount.
    Price is per year.
    Data is in ASC II or Comma Delimited format on Compact Disc.
- Nationally by HCPCS Code by Carrier by Locality
  - PTBTBL15
    Medicare Part B Expenditures, Nationally by HCPCS Code by Carrier by Locality for calendar years 1996-2001: Elements contained in this table: Allowed Services, Allowed Charges, Denied Services, Denied Amount, Percent Denied and National Allowed Charges ranking.
    Price is per year.
    Data is in ASC II or Comma Delimited format on a compact disc.
- Nationally by Specialty by HCPCS Code by Carrier
  - PTBTBL16
    Medicare Part B Expenditures, Nationally by Specialty by HCPCS Code by Carrier for calendar years 1996-2001: Elements contained in this table: Allowed Services, Allowed Charges, Denied Services, Denied Amount, and National Allowed Charges ranking.
    Price is per year.
    Data is available on Compact Disc in ASC II or Comma Delimited format.
- Nationally by HCPCS Code
  - PTBTBL17
    Medicare Part B Expenditures, Nationally by HCPCS Code for calendar years 1996-2001: Elements contained in this table: Total Service, Allowed Services, MTUS, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, Payment Amount, Allowed Charges as a Percent of Total, Percent Denied and National Allowed Charges ranking.
    Price is per year of data and is delivered on compact disc in Excel, ASCII or Comma Delimited format
Inpatient Hospital Medicare Reimbursement
- Medicare Inpatient National Statistics
  - INPTBL01
    Medicare Inpatient National statistics for all Inpatient facilities and also National statistics by PPS and PPS-Exempt Hospitals.
- Medicare Inpatient National Statistics by Age
  - INPTBL02
    Medicare Inpatient National statistics, by Age, divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Inpatient National Statistics by Race
  - INPTBL03
    Medicare Inpatient National statistics, by race, divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Inpatient National Statistics by Gender
  - INPTBL04
    Medicare Inpatient National statistics, by gender, divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Inpatient National Statistics by Provider State
  - INPTBL05
    Medicare Inpatient National statistics, by Provider State, Nationally as well as divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Inpatient National Statistics by Provider
  - INPTBL06
    Medicare Inpatient National statistics, by Provider, divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Inpatient National Statistics by Principal Diagnosis
  - INPTBL07
    Medicare Inpatient National statistics, by Principal Diagnosis, divided by PPS and PPS-Exempt Hospitals. Click here for a list of the elements contained in these files
- Medicare Hospital Discharges, Acute Care
  - INPTBL21
    Medicare Hospital Discharges, Nationally by State for calendar years 1994-1998: Elements contained in this table: Total Discharges by Type of Discharge, viz. Home, Death, Institutions, and Other. This table also contains the percentage of each discharge type to national Medicare total discharges. All years sold together at a discount when you choose to view them online
- Medicare Hospital Summaries, Acute Care
  - INPTBL22
    Medicare Hospital Summaries, Nationally by DRG for calendar years 1996-1998. Elements contained in this table: DRG Code and Descriptions, Medicare Reimbursement, and Total Days. The DRG's are divided into Surgical, Medical and Other DRG classifications. Choose whether you want your reports ranked by Average Reimbursement per Discharge, Total Medicare Reimbursement, Average Total Days, or DRG. Price given is per year.
    All years sold together at a discount when you choose to view them online
- Medicare Hospital Discharges, Long Term Care
  - INPTBL31
    Medicare Hospital Discharges, Nationally by State for calendar years 1994-1998: Elements contained in this table: Total Discharges by Type of Discharge, viz. Home, Death, Institutions, and Other. This table also contains the percentage of each discharge type to national Medicare total discharges. Price given is per year.
    All years sold together at a discount when you choose to view them online
- Medicare Hospital Summaries, Long Term Care
  - INPTBL32
    Medicare Hospital Summaries, Nationally by State for calendar years 1995-1998: Elements contained in this table: Number of days by type of Long Term Care facility, viz. Rehabilitation, Christian Science, Psychiatric, Children, etc. Price given is per year.
    All years sold together at a discount when you choose to view them online
- Other PPS & PPS-Exempt Tables (Price to be determined based on requirements). Available by:
  - Provider State by Age
  - Provider State by Race
  - Provider State by Gender
  - Provider State by Principal Diagnosis
  - Provider State by admitting Diagnosis
  - Provider State by DRG
  - Provider, by DRG
  - Gender, by Age, by Race
  - Gender, by Age by Race by Principal Diagnosis
  - DRG
  - ETC.
  - Contact us today to let us know how we can help you.
Enrollment Statistics
- FREE--Medicare Beneficiaries Enrolled by State
  - This table is a summary by state showing the Medicare population and the change over time, through 2001.
- Annual County Enrollment File
  - ENRTBL01
    This file contains aged enrollment data by age range, race, and sex by county, State, census region, and division codes, including county names. The file is usually produced in April and reflects enrollment as of July 1, of the previous year. This file is available from 1987 through 1999. Although this file has been edited to protect the privacy of Medicare beneficiaries, it does not meet the current Privacy Act provision therefore a Data Use Agreement (DUA) is required to be signed by the requester/s in order that this be supplied. Will be shipped on compact disc(s).
- Annual Zip Code Enrollment File
  - ENRTBL02
    This file contains aged and disabled enrollment data by age range, race, and sex within ZIP code. The file is usually produced in April and reflects enrollment as of July 1, of the previous year. This file is available from 1992 - 1999. Although this file has been edited to protect the privacy of Medicare beneficiaries, it does not meet the current Privacy Act provision therefore a Data Use Agreement (DUA) is required to be signed by the requester/s in order that this be supplied.
    Media: Compact Disc/s
    Format: ASCII, EXCEL, CDF or SAS
- Medicare HMO Market Penetration by State
  - ENRTBL05
    These files provide a graphic representation of the number of HMO enrollees by State. The associated tables of information contain the Total Medicare population by State, the HMO population and the percentage of HMO beneficiaries to the Total population of the State. These tables contain all States.
    Media: Diskette, CD or online
    File Format: ASCII, Comma Delimited, Excel or HTML
    Availability: Calendar Years 1994 - 1998
    Price given is per year. All years sold together at a discount when you choose to view them online
    We have made the table for one state available as an example
    Note: ALL CELLS LESS THAN 11 HAVE BEEN SUPPRESSED
- Medicare HMO Market Penetration by State by County
  - ENRTBL10
    These tables of information contain the Total Medicare population by State and County, the Year-end HMO population, the Total HMO Enrollment per Month and the Total person Months of HMO Enrollment. These tables contain all States.
    Media Type: Diskette, CD or online
    File Format: ASCII, Comma Delimited, Excel and HTML
    Available CY1994 - 1998
    Price given is per year. All years sold together at a discount when you choose to view them online
    We have made the table for one state available as an example
    Note: ALL CELLS LESS THAN 11 HAVE BEEN SUPPRESSED
- Medicare Enrollment and Entitlement
Cost Limits
- Medicare HHA Cycle 16 Data Set
  - PUBTBL42
    This file contains cost, statistical and other data used in establishing the Home Health Agency (HHA) Cost Limits for fiscal periods beginning after October 1, 1999. The cost and statistical data were obtained from Free Standing Medicare HHA cost reports (Form 1728-94) for full cost reporting periods on or after October 1, 1994 and settled by March 1999. This file also contains the applicable hospital wage index and HHA Market Basket Adjustment Factor.
    Media: Diskette or C D
    Format: ASCII, EXCEL, CDF or SAS
    Note: Historical Files--Cycle 10 (7/1/92) through Cycle 15 (7/1/97)--also available here as an add on to this file.
- Medicare HHA ABL Cycle 1 Data Set
  - PUBTBL44
    This file contains data used to calculate the Home Health Agency (HHA) Aggregate Beneficiary Limits (ABL) for cost reports beginning on or after October 1, 1997, as required by the Balanced Budget Act of 1997. The calculation of the limitations required that we use unduplicated census counts for each provider that were calculated from the National Claims History File and are included in the file. The file was created using the most recent settled cost report data for both freestanding and hospital based providers. The file also contains applicable hospital wage index and HHA Market Basket Adjustment Factor.
    Media: Diskette or C D
    Format: ASCII, EXCEL, CDF or SAS
- Medicare HHA ABL Cycle 2 Data Set
  - PUBTBL46
    This file contains data used to calculate the Home Health Agency (HHA) Aggregate Beneficiary Limits (ABL) for cost reports beginning on or after October 1, 1998, as required by the Balanced Budget Act of 1997. The calculation of the limitations required that we use unduplicated census counts for each provider that were calculated from the National Claims History File and are included in the file. The file was created using the most recent settled cost report data for both freestanding and hospital based providers. The file also contains applicable hospital wage index and HHA Market Basket Adjustment Factor.
    Media: Diskette or C D
    Format: ASCII, EXCEL, CDF or SAS
- Medicare HHA ABL Cycle 3 Data Set
  - PUBTBL48
    This file contains data used to calculate the Home Health Agency (HHA) Fiscal Year (FY) 2000 update for the Aggregate Beneficiary Limits (ABL) as required by the Balanced Budget Act of 1997. The calculation of the limitations required that we use unduplicated census counts for each provider that were calculated from the National Claims History File and are included in the file. The file was created using the most recent settled cost report data for both free-standing and hospital based providers for cost reports ending in Federal Fiscal Year 1994. The file contains applicable HHA Market Basket Adjustment Factor.
    Media: Diskette or C D
    Format: ASCII, EXCEL, CDF or SAS
- Medicare Home Health Agency Cycle 13 Agency Data Set
  - PUBTBL50
    The file contains data obtained from Freestanding and Hospital-based Medicare HHA cost reports for full cost reporting periods beginning on or after May 31, 1991, and settlement dates before October 10, 1995. The data for each provider are MSA code, type of agency (freestanding or hospital-based), labor and non-labor cost for each of the six types of visits, and the number of visits by type. The costs are those taken directly from the cost reports before being inflated to reflect costs as of July 1, 1998. The market-basket inflation factor used to inflate costs from the end of the cost reporting period to July 11997, is contained in the file as is the wage index factor.
    Media: Diskette or CD
    Format: ASCII, EXCEL, CDF or SAS
Cost Reports
- Renal Dialysis Facilities Set
  - PUBTBL60
    The Renal Dialysis Facilities Cost Report Extract contains cost and statistical data for freestanding and hospital-based renal dialysis providers. The data are in two separate files on each diskette. The data set includes only the most precise version of each cost report filed with CMS. This data is available for 1996 - 1999 and is normally updated quarterly and is available on the last day of the month following quarter end.
    Media: Diskette or CD
    Format: ASCII or PKZIP (compressed), CDF or SAS
- Home Health Agency Cost Report Master File
  - PUBTBL62
    The Home Health Agency Cost Report Master File contains one copy of each version (as submitted, settled, reopened) of each HCFA-1728-94 cost report filed by the Provider. The data comprise every line item originally included in the cost report extract created for CMS by the Medicare Fiscal Intermediary. The earliest cost reports on the file are those with beginning dates of January 1, 1994. The file is updated on a flow basis as cost report extracts are received at CMS for successive fiscal periods until the HCFA-1728-94 form is obsolete.
    Media: Compact Disc
    Format: ASCII, CDF or SAS
- HHA Practical Data Set
  - PUBTBL64
    The HHA Practical Data Set contains statistical and utilization data, total cost and Medicare cost by cost center, settlement date and financial data for Medicare-certified free standing, hospital-based, and skilled nursing facility (SNF)-based HHA. The data sets include only the most current report (as submitted, final settled or reopened) submitted for a certified facility by the Medicare Fiscal Intermediary to CMS. These data sets are updated at the end of each calendar quarter and are available on the last day of the following month. These data are available from 1994 - 1997
    Media: Compact Disc
    Format: ASCII, CDF. SAS
- Hospital Cost Report System Master File
  - PUBTBL66
    The Hospital Cost Report System Master File contains one copy of each version (as submitted, settled, reopened) of each HCFA-2552 ( 10/01/91 and before 09/26/96), and HCFA-2552-96 (09/30/96 to current) cost report filed with CMS. The data consists of every data element included in the Hospital Cost Report Information System (HCRIS) extract created for CMS by that provider's fiscal intermediary. These files are updated as cost reports are received at CMS. These are available from 1991 - 1998.
    Media: Compact Disc
    Format: ASCII, CDF or SAS
- PPS IX-XII Capital Data Set
  - PUBTBL68
    The Capital Data Set contains selected data for capital-related costs, interest expense and related information, and complete balance sheet data from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare Certified Hospital by the Medicare Fiscal Intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. This data is available from 1991 - 1995. This data for 1996 to current has been included as part of The PPS Hospital data set below.
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability:
    - PPS IX-for periods beginning on or after 10/01/91 and before 10/01/92
    - PPS X-for periods beginning on or after 10/01/92 and before 10/01/93
    - PPS XI-for periods beginning on or after 10/01/93 and before 10/01/94
    - PPS XII-for periods beginning on or after 10/01/94 and before 10/01/95
- PPS Exempt Units
  - PUBTBL70
    The Exempt Hospitals and Excluded Units file contains cost, statistical and ancillary charge data for hospitals and sub-providers of hospitals that are exempt from the Prospective Payment System (PPS). The data set includes only the most precise version of the cost report filed with CMS. The data set is normally updated quarterly and is available on the last day of the month following quarter end. This is available from 1991 - 1995. This data for 1996 to current has been included as part of The PPS Hospital data set
    Media: Diskette or CD
    Format: ASCII, PKZIP, CDF or SAS
    Availability:
    - PPS IX-for periods beginning on or after 10/01/91 and before 10/01/92
    - PPS X-for periods beginning on or after 10/01/92 and before 10/01/93
    - PPS XI-for periods beginning on or after 10/01/93 and before 10/01/94
    - PPS XII-for periods beginning on or after 10/01/94 and before 10/01/95
- PPS IV-XII Minimum Data Set
  - PUBTBL72
    The Minimum Data Set contains cost, statistical, financial, and other data from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare Certified Hospital by the Medicare Fiscal Intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. These data are available from 1987 - 1995 (See The PPS Hospital data set for other years).
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability:
    - PPS IV-for periods beginning on or after 10/01/86 and before 10/01/87
    - PPS V-for periods beginning on or after 10/01/87 and before 10/01/88
    - PPS VI-for periods beginning on or after 10/01/88 and before 10/01/89
    - PPS VII-for periods beginning on or after 10/01/89 and before 10/01/90
    - PPS VIII-for periods beginning on or after 10/01/90 and before 10/01/91
    - PPS IX-for periods beginning on or after 10/01/91 and before 10/01/92
    - PPS X-for periods beginning on or after 10/01/92 and before 10/01/93
    - PPS XI-for periods beginning on or after 10/01/93 and before 10/01/94
    - PPS XII-for periods beginning on or after 10/01/94 and before 10/01/95
- PPS IX-XII Medicare Part B Data Set
  - PUBTBL74
    This file contains Part B Medicare cost and charges by cost center from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare certified hospital by the Medicare Fiscal Intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. These data are available from 1991 - 1995 (See The PPS Hospital data set for other years).
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability:
    - PPS IX- for periods beginning on or after 10/01/91 and before 10/01/92
    - PPS X-for periods beginning on or after 10/01/92 and before 10/01/93
    - PPS XI-for periods beginning on or after 10/01/93 and before 10/01/94
    - PPS XII-for periods beginning on or after 10/01/94 and before 10/01/95
- Worksheet A Data Set
  - PUBTBL76
    The Worksheet A Data Set file contains the extract of the trial balance portion of HCFA-2552-92 Hospital Cost Reports. The data set includes only the most precise version of the cost report filed with CMS(previously HCFA). The data set is normally updated quarterly and is available on the last day of the month following quarter end. These data are available from 1991 - 1995 (See The PPS Hospital data set for other years).
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability:
    - PPS IX-for periods beginning on or after 10/01/91 and before 10/01/92
    - PPS X-for periods beginning on or after 10/01/92 and before 10/01/93
    - PPS XI-for periods beginning on or after 10/01/93 and before 10/01/94
    - PPS XII-for periods beginning on or after 10/01/94 and before 10/01/95
- PPS Hospital Data Set
  - PUBTBL80
    The PPS Hospital Data Set contains cost, statistical, financial, and other data from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare Certified Hospital by the Medicare Fiscal Intermediary to CMS(previously HCFA). The data set is updated at the end of each calendar quarter and is available on the last day of the following month.
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability Periods:
    - PPS XIII- FY96 for periods beginning on or after 10/01/95 and before 10/01/96
    - PPS XIV- FY97 for periods beginning on or after 10/01/96 and before 10/01/97
    - PPS XV - FY98 for periods beginning on or after 10/01/97 and before 10/01/98
    - Data prior to 10/01/95 will remain available as separate files.

- Upon release of the new Hospital Data Set the following data sets will no longer exist as individual files for current and future years:
  1. PUBTBL68 - Capital Data Set
  2. PUBTBL70 - PPS Exempt Units Data Set
  3. PUBTBL72 - PPS Minimum Data Set
  4. PUBTBL74 - Medicare Part B Data Set
  5. PUBTBL76 - Worksheet A Data Set
    However, these historical data will remain available as separate files. Upon release of the new Hospital Data Set the above data sets will no longer exist as individual files for current and future years.
- Skilled Nursing Facility Minimum Data Set
  - PUBTBL82
    The Skilled Nursing Facility (SNF) Minimum Data Set contains cost, statistical, financial and other data from the Medicare SNF Cost Report and Hospital-Based SNF Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare Certified SNF by the Medicare Fiscal Intermediary to CMS(previously HCFA). This data set is updated at the close of each calendar quarter and is available on the last day of the following month.
    Media: Compact Disc
    Format: ASCII, CDF or SAS
    Availability:
    - Year 1 - Beginning on or after 10/01/88 and before 10/01/89
    - Year 2 - Beginning on or after 10/01/89 and before 10/01/90
    - Year 3 - Beginning on or after 10/01/90 and before 10/01/91
    - Year 4 - Beginning on or after 10/01/91 and before 10/01/92
    - Year 5 - Beginning on or after 10/01/92 and before 10/01/93
    - Year 6 - Beginning on or after 10/01/93 and before 10/01/94
    - Year 7 - Beginning on or after 10/01/94 and before 10/01/95
    - Year 8 - Beginning on or after 10/01/95 and before 10/01/96
    - Year 9 - Beginning on or after 10/01/96 and before 10/01/97
    - Year 10- Beginning on or after 10/01/97 and before 10/01/98
- Skilled Nursing Facility Cost Report System Master File
  - PUBTBL84
    The Skilled Nursing Facility Cost Report System Master File contains one copy of each version (as submitted, settled, reopened) of HCFA-2540 cost report filed by the provider with CMS(previously HCFA). The data comprise every line item originally included in the cost report extract created for CMS by the Medicare Fiscal Intermediary. These files are updated on a flow basis as cost report extracts are received at CMS.
    Media: Cartridge
    Availability:
    - HCFA-2540-92 covers 1993,1994, 1995
    - HCFA-2540-96 covers 1996, 1997, 1998
Payment Rates
- Institutional Providers
  - AOR/BOR Tables
    - PRITBL10
      This diskette contains data used to develop the Diagnosis Related Group (DRG) relative weights. It contains mean, maximum, minimum, standard deviation, and coefficient of variation statistics by DRG for length of stay and standardized charges. The BOR tables are "Before Outliers Removed" and the AOR is "After Outliers Removed". (Statistical Outliers, not Payment Outliers.)
      Media: Diskette and Compact Disc
      Format: ASCII
      Available: FY 2001 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - DRG's Relative Weights
    - PRITBL15
      This file contains a listing of Diagnosis Related Group (DRG) narrative description, relative weight, geometric mean, length of stay, and day outlier trim points. This table is published in the Federal Register as part of the Prospective Payment System Notice of Proposed Rule Making and the Final Notice.
      Media: Diskette and Compact Disc
      Format: ASCII
      Available: FY 2001 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - CMS(previously HCFA) Medicare Case-Mix Index File
  - CMS(previously HCFA) Wage Data
    - PRITBL25
      This file contains the hospital hours and salaries used to create the wage indices used in the Medicare Hospital Prospective Payment System (PPS).
      Media: Diskette and Compact Disc
      Format: ASCII
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - CMS(previously HCFA) Hospital Wage Indices
    - PRITBL30
      (Formally: Urban/Rural/Hospital/Wage Indices)This file contains a history of all wage indices used since October 1, 1983.
      Media: Diskette
      Format: ASCII
      Available: FY 2000 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - PPS Payment Impact File
    - PRITBL35
      This file contains data used to estimate FY 1999 payments under Medicare's Prospective Payment System (PPS) for capital costs. The data are taken from various sources, including the Provider Specific File, the PPS-X and PPS-XI Minimum Data Sets, and prior impact files. The data set is abstracted from an internal file used for the impact analysis of the changes to PPS published in the Federal Register. This file is available for release one month after the Final Rule is published in the Federal Register, usually during the first week of September.
      Media: Diskette or CD
      Format: ASCII
      Available: FY 2001 PPS Update
  - PPS Standardizing File
    - PRITBL40
      This file contains information that standardizes the charges used to calculate relative weights to determine payments under PPS. Variables include wage index, Cost of Living Adjustment (COLA) case mix index, disproportionate share, and the Metropolitan Statistical Area (MSA). A new file is created for both the Notice of Proposed Rule Making (NPRM) and the Final Rule. The records are in provider number sequence, however, it is possible to have missing values in some records.
      Media: Diskette or CD
      Format: ASCII
      Available: FY 2001 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - Provider Specific File
    - PRITBL45
      This file is a component of the PRICER program used in the Fiscal Intermediary's (FI) system to compute individual hospital Diagnosis Related Group (DRG) payments. The file contains records for all Prospective Payment System (PPS) eligible hospitals, including hospitals in waiver states. Data elements used in the PPS calibration processes and related PPS activities are also included.
      Media: Diskette or CD
      Format: ASCII
      Available: FY 2001 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - Reclassified Hospitals
    - PRITBL50
      This file contains a listing of hospitals that were reclassified for the purpose of assigning a new wage index.
      Media: Diskette or CD
      Format: ASCII
      Available: FY 2001 PPS Update
      1. The Notice of Proposed Rule Making (NPRM) is usually published in the Federal Register, by the end of May.
      2. The Final Rule is usually published in the Federal Register, by the first week of September.
  - SNF Prospective Payment Rates
    - PRITBL55
      This file contains cost, statistical, and other data used in establishing the Skilled Nursing Facility (SNF) prospective payment rates published in the Federal Register May 14, 1998 for cost reporting periods beginning on or after July 1, 1998. The cost and statistical data are obtained from the hospital-based SNF and freestanding SNF (Forms 2552, 2540, and 2540S). This file also contains the standardization factors and case-mix correction factors.
      Media: Diskette or CD
      Format: ASCII
      Available: July 1, 1998
  - Home Health Prospective Payment System
    - PRITBL60
      The files included under this section were used in the development of the Home Health Prospective Payment System (HH PPS) for which the Notice of Proposed Rule Making (NPRM) was published in the Federal Register on October 28, 1999. The audited cost report file contains audited cost reports for sample agencies with cost reporting periods ending in fiscal year 1997. The provider level utilization file, derived from National Claims History (NCH) data is combined with wage index value data, and contains visit totals for the 6 disciplines. These are: skilled nursing, physical therapy, occupational therapy, speech language therapy, medical social, and home health aide as well as the total number of episodes (for both episodes with less than or equal to 4 visits and for episodes with greater than 4 visits) aggregated to the provider level. The HCPCS file contains the procedure codes identified as non-routine medical supply codes that could be unbundled and billed under Part B. Finally, the grouper pseudo code file contains the logic for the classification of patients into one of the Home Health Resource Groups (HHRG) used in determining the episode payment. When utilized in a manner similar to that described in the NPRM, these files can help interested parties in their understanding and analysis of this proposed system.
      Media: Diskette or CD
      Format: ASCII
      Available: October 1999
- Non-Institutional Providers
  - Medicare Ambulatory Surgical Center (ASC) Procedures and Payment Groups
    - PRNTBL10
      FORMERLY: ASC BASE ELIGIBILITY FILE
      This file contains the procedure codes that may be performed in an ASC under the Medicare program and the ASC payment group assigned to each of the procedure codes. The ASC payment group determines the amount that Medicare pays for facility services furnished in connection with a covered procedure. This file is updated annually usually in April.
      Media: Diskette or CD
      Format: ASCII
      Available: CY 2000
      Procedure Codes (CPT4) are copyright of the AMA/ADA.
  - Annual Physician Fee Schedule Payment Amount--Selected Carrier
    - PRNTBL25
      This file contains locality-specific pricing amounts for services covered by the Medicare Physician Fee Schedule. The file contains one record for the unique combination of carrier, locality, procedure, and certain modifiers. Additionally, the file contains the Relative Value Units (RVU) associated with the service and the Geographic Practice Cost Indices (GPCI) associated with the locality. This file is a subset of the Annual Physician Fee Schedule Payment Amount File -- National. This file is available after publication in the Federal Register, usually in late November. The current year file will be updated periodically to incorporate midyear changes. Updated files will be available on April 1, July 1, and October 1. Files purchased after January 1 will contain pricing data for carrier-priced services for the prior year. The files for the years 1992-1995 contain transition and full fee amounts. Files for the year 1996 forward contain only the full fee amounts because the transition period has ended.
      Media: Compact Disc/s
      Format: ASCII, CDF or SAS
      Available: CY 1992 through CY 2000
      Procedure Codes (CPT4) are copyright of the AMA/ADA.
  - Annual Physician Fee Schedule Payment Amount-National
    - PRNTBL20
      This file contains one record for each unique combination of carrier, locality, procedure, and certain modifiers. Additionally, the file contains the Relative Value Units (RVU) associated with the service and the Geographic Practice Cost Indices (GPCI) associated with each locality. This file is available after publication in the Federal Register, usually in late November. The current year file will be updated periodically to incorporate midyear changes. Updated files will be available on April 1, July 1, and October 1. Files purchased after January 1 will contain pricing data for carrier-priced services for the prior year. The files for the years 1992-1995 contain transition and full fee amounts. Files for the year 1996 forward contain only the full fee amounts because the transition period has ended.
      Media: Compact Disc/s
      Format: ASCII, CDF or SAS
      Available: CY 1992 through CY 2000
      Procedure Codes (CPT4) are copyright of the AMA/ADA.
  - Clinical Diagnostic Lab Fee Schedule National/Carrier
    - PRNTBL30
      This file contains the carrier-specific fee schedules and national limitation amounts for the clinical laboratory services that are covered under the Clinical Diagnostic Laboratory Fee Schedule. The 1995 file contains pricing amounts for all clinical laboratory codes. For 1995 and 1996, each carrier's data are contained in a separate file; a total of 55 separate files are on the diskette. For 1997 and forward, all carrier-specific fee schedules and national limitation amounts will be contained in one file. For each unique combination of procedure, carrier, and locality, these files contain the carrier 60% and 62 % fee schedules and the 60% and 62% national limitation amounts. The locality field on these files identifies States for multi-State-carriers. This file is usually released in December for the following year.
      Price given is per year for either National or Carrier Specific
      Media: Diskette or Compact Disc/s
      Format: ASCII, EXCEL, CDF or SAS
      Available: CY 1993 - 2000
      Procedure Codes (CPT4) are copyright of the AMA/ADA.
  - Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) Fee Schedule
    - PRNTBL35
      This file contains a fee schedule amount, floor, ceiling, jurisdiction, and category for each unique combination of procedure code, modifier code (where applicable), and State of provider and beneficiary. The file is sorted in ascending DMEPOS category/procedure code/modifier order. The DMEPOS fee schedule will be updated on a quarterly basis, with the January 1 implementation date being the primary update. In addition to the January file, updated files will be available in early April, July, and October. These files will be complete replacement files for the DMEPOS fee schedule, not only the quarterly changes.
      Media: Diskette or Compact Disc/s
      Format: ASCII, EXCEL, CDF or SAS
      Available: CY 2000
  - National Physician Fee Schedule Relative Value File
    - PRNTBL40
      This file contains information on procedure codes covered under the Medicare Physician Fee Schedule. For more than 10,000 physician services, the file contains the associated Relative Value Units (RVU), a fee schedule coverage indicator, and various payment policy indicators needed for payment adjustments (i.e., payment of assistant at surgery, team surgery, billable medical supplies, etc.). The file contains one record for each unique combination of procedure code and modifier. This file is available after publication in the Federal Register, usually in late November. Current year file will be updated periodically to incorporate midyear changes. Updated files will be available on April 1, July 1, and October 1. This file will contain a separate file of the Geographic Practice Cost Indices (GPCI) for 1997 and forward.
      Media: Diskette or Compact Disc/s
      Format: ASCII, EXCEL, CDF or SAS
      Available: CY 1992 through CY 2000
      Procedure Codes (CPT4) are copyright of the AMA/ADA.
Healthcare Providers
- Provider of Services File
  - PROTBL10
    The Provider of Services (POS) Extract is created from the Online Survey and Certification Reporting System (OSCAR) Database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the CMS Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly.
    Media: Compact Disc/s
    Format: ASCII, CDF or SAS
    Available: CY 1991 through CY 1999
    File Categories-See Medicare FAQ's for method of identifying
    1. Provider Categories
    2. Hospital
    3. SNF/NF (dually)
    4. SNF/NF (distinct)
    5. Skilled Nursing Facilities (SNF)
    6. Home Health Agencies (HHA)
    7. Medicare Laboratories
    8. Portable X-rays
    9. Physical Therapy/Speech Pathology
    10. End Stage Renal Disease (ESRD)
    11. Nursing Facilities (NF)
    12. Intermediate Care Facility - Mentally Retarded (ICF/MR)
    13. Rural Health Clinic
    14. Physical Therapy - Independent Practice
    15. Comprehensive Outpatient Rehab Facilities (CORF)
    16. Ambulatory Surgical Centers (ASC)
    17. Hospices
    18. Organ Procurement Organization
    19. CLIA67 Laboratories
    20. Community Mental Health Centers (CMHC)
    21. Screening Mammography
    22. Federally Qualified Health Centers
    23. CLIA88 Laboratories ÷ added: effective 1997
- ESRD Renal Provider File
  - PROTBL20
    The End Stage Renal Disease (ESRD) Renal Provider File contains Medicare approved providers who furnish kidney dialysis and/or kidney transplant services. It includes the location of the providers and the range of renal services available at those providers. This file is updated twice a year, i.e. January and July four weeks after publication in the Federal Register.
    Media: Diskette
    Format: ASCII
    Available: January 2000 Update
- Medicare Part B Durable Medical Equipment Suppliers
  - PROTBL30
    This file contains the names, physical addresses, mailing addresses, telephone numbers, owners, types of business, and other information regarding active suppliers of durable medical equipment, prosthetics, orthotics, and supplies that have been issued Medicare supplier numbers by the National Supplier Clearinghouse. Suppliers submitted this information on HCFA Form 192. This data set is updated quarterly and is available on the last day of the following month.
    Media: Compact Disc/s
    Format: ASCII, CDF or SAS
    Available: 2000
    The data contains six different types of records:
    1. Supplier Information
    2. Supplier Specialty Information
    3. Supplier Relation Data
    4. Tax/Claims/Pay Information
    5. License Information
    6. Supplier Alias Information
- Provider of Services-Hospital Listing
  - PROTBL40
    The listing contains the hospital Medicare provider number, facility name, address, city, State, and ZIP code.
    Media: Diskette or Compact Disc/s
    Format: ASCII, CDF or SAS
    Available: CY1996 through CY1999
Other Reference/Data Files
- Berenson-Eggers Type of Services (BETOS) File
  - OTHTBL10
    This file contains procedure codes and the BETOS code assigned. Each procedure code file includes the descriptions of the BETOS codes.
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 2000
    Procedure Codes (CPT4) are copyright of the AMA/ADA.
- Carrier/Locality State and County File
  - OTHTBL12
    This file contains a record for each unique combination of carrier, locality, State, and county. It contains carrier number, carrier locality code name, Federal Information Processing Standards (FIPS) State and county codes, Social Security Administration (SSA) State and county codes, and Metropolitan Statistical Area/Business Enterprise Area (MSA/BEA) assignment. There are no further updates for this file and it can be used for working with Carrier claims for years preceding 1999 to determine geography.
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1998
- ICD-9-CM Conversion Software Files
  - OTHTBL14
    The purpose of the Electronic ICD-9-CM Diagnosis and Procedure Conversion Table Reporting System for FY 1986 to FY 1998 is to provide a systematic approach to tracking modifications to codes and/or descriptions made to ICD-9-CM each year. CMS(previously HCFA) and the National Center approved the system for Health Statistics (NCHS). The system contains tables sorted and presented in different orders for easy comment on code changes. This Electronic Reporting System (ERS) is the official version of the code changes. The system is updated after the publication of the final rule on code changes in the Federal Register usually the first week of September.
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1998
    Note: No further updates available for this file.
- ICD-9-CM Version 17.0 File
  - OTHTBL16
    This diskette includes the following files and a corresponding abbreviated narrative description of each file. These files are updated after the publication of the Final Rule in the Federal Register, usually by the first week of September
    a. Major Diagnostic Category (MDC)
    b. Diagnosis Related Group (DRG)
    c. ICD-9-CM Diagnostic Code
    d. ICD-9-CM Procedure Code
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1999 PPS Update
- PPS SSA/FIPS MSA-State and County Crosswalk File
  - OTHTBL18
    This file contains a crosswalk of state and county codes used by the Social Security Administration (SSA) and the Federal Information Processing Standards (FIPS), county name, and a historical list of Metropolitan Statistical Areas (MSA).
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1999 PPS Update
    1. The Notice of Proposed Rule Making (NPRM) is published in the Federal Register, by the end of May.
    2. The Final Rule is published in the Federal Register, usually by the first week of September.
- ESRD Renal Facility Survey File
  - OTHTBL20
    The End Stage Renal Disease (ESRD) Renal Facility Survey data are collected annually by CMS(previously HCFA) from all facilities certified to provide Medicare-covered renal dialysis and transplantation. The survey, which includes the entire United States, uses Form HCFA 2744 and encompasses the full calendar year. Geographical data are included to the level of ZIP code for the facility. Each record contains facility information and information on the number of patients served and the number of dialysis treatments provided. It also contains the number of kidney transplants performed. The data includes services to both Medicare and non-Medicare patients. This file is produced annually and is usually available in July.
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1987 - CY 1999
- Hospital Service Area File
  - OTHTBL22
    This file is derived from the calendar year inpatient claims data. The records contain number of discharges, length of stay, and total charges summarized by provider number and ZIP code of the Medicare beneficiary. This file is produced annually and is usually available in May.
    Media: Diskette
    Format: ASCII or EXCEL
    Available: CY 1986 - 1999

Medicaid

Medicaid Statistical File

MDCTBL10
The file contains the complete Form HCFA-2082, Statistical Report on Medical Care; Eligible, Recipients, Payments and Services, a report of Medicaid cost and utilization data that is submitted annually by States, territories, and the District of Columbia. The report summarizes data on Medicaid- eligible recipients, service utilization, and medical vendor payments on a federal fiscal year basis. All data are reported on the basis of individuals who receive medical care, rather than cases or families.
Media: Compact Disc/s
Format: SAS

Available:	Comments:
Fiscal Year 1994	Data for Sections C through N are excluded for Rhode Island and Puerto Rico.
Fiscal Year 1995:	Sections I through N are excluded for Virgin Islands except for Sections L (1) and (2). Data for Sections C through N are excluded for Rhode Island and Puerto Rico.
Fiscal Year 1996:	Sections I through N are excluded for Virgin Islands except for Sections L (1) and (2). Data for Sections C through N are excluded for Puerto Rico. Florida data were estimated from test data for the Medicaid Statistical Information System (MSIS). Hawaii data do not include eligible or recipients associated with their QUEST capitation population.
Fiscal Year 1997:	Virgin Islands did not submit data for Sections D (1) and D (4). Sections I through N are excluded except or Sections L(1) and (2). Puerto Rico and Hawaii submitted total recipients and payments only. The recipient is also used as the eligible total for these two Jurisdictions. Oklahoma submitted totals throughout the HCFA-2082. Nebraska excluded data for Sections E, F (1), F (2), and Sections I through N. Maine submitted totals in Sections D (1), (2), and (3).
Fiscal Year 1998:	Puerto Rico submitted total recipients and payments only. The recipient total is also used as the eligible total. Oklahoma submitted total recipient counts for Sections A, B, C, and D only. Nebraska submitted complete data in Sections A, B, C, and D only.

Medicaid Drug Utilization by State by Quarter
- MDCTBL20
  The Medicaid Drug Utilization file contains State by State information on drug utilization by the Medicaid program. All drugs are identified by National Drug Code (NDC). The drug utilization is reported by individual drug products and includes the number of units of the drug that were reimbursed by the Medicaid program. The file also contains information on the number of prescriptions filled for each drug. No pricing data are included. The quarterly file consists of approximately 500,000 records and is continuously updated.
  Media: Compact Disc/s
  Format: ASCII or SAS
  Available: Beginning 1/91 through current calendar quarter
Medicaid Statistical File--Diskette
- MDCTBL30
  This file is based on information reported to CMS(previously HCFA) by 50 States, the District of Columbia, Puerto Rico, and the Virgin Islands. The information is reported on the Form HCFA 2082, Statistical Report on Medical Care: Eligible, Recipients, Payments, and Services. These tables are provided as a public service. CMS cannot guarantee the accuracy of the data that were obtained from State Medicaid agencies.
  1. Sections A, B, and part of E and H (age, sex, and race) of the HCFA 2082 report are extracted for fiscal year 1990.
    Media: Diskette or Compact Disk
  2. Sections I, J, N of the HCFA 2082 are excluded for fiscal years 1991 and 1992.
  3. Sections I, J, M, and N of the HCFA 2082 report are excluded for fiscal years 1993 and 1994.
  4. Fiscal Year 1995:
    - Sections I through N are excluded for Virgin Islands except for Sections L(1) and (2).
    - Data for Sections C through N are excluded for Puerto Rico.
  5. Fiscal Year 1996:
    - Sections I through N are excluded for Virgin Islands except for Sections L (1) and (2). Data for Sections C through N are excluded for Puerto Rico. Florida data were estimated from test data for the Medicaid Statistical Information System (MSIS). Hawaii data do not include eligible or recipients associated with their QUEST capitation population.
  6. Fiscal Year 1997:
    - Virgin Islands did not submit data for Sections D (1) and D(4). Sections I through N are excluded except or Sections L(1) and (2). Puerto Rico and Hawaii submitted total recipients and payments only. The recipient total is also used as the eligible total for these two Jurisdictions. Submitted Oklahoma totals throughout the HCFA-2082. Nebraska excluded data for Sections E, (1), F (2), and Sections I through N. Maine submitted totals in Sections D (1), (2), and (3).
  7. Fiscal Year 1998:
    - Puerto Rico submitted total recipients and payments only. The recipient total is also used as the eligible total. Oklahoma submitted total recipient counts for Sections A, B, C, and D only. Nebraska submitted complete data in Sections A, B, C, and D only.
  Media: Diskette and Compact Disc
  Format: ASCII Print file of individual tables or Excel
  Available: FY 1993 through FY1998

Online Access
- Hospital Inpatient Medicare Reimbursement Statistics
  - Medicare Hospital Discharge, Acute Care
    - INPONL21
      Immediate online access Medicare Hospital Discharges, Nationally by State for calendar years 1994-1998: Elements contained in this table: Total Discharges by Type of Discharge, viz. Home, Death, Institutions, and Other. This table also contains the percentage of each discharge type to national Medicare total discharges.
      View them online or download Excel Files.
  - Medicare Hospital Summaries, Acute Care
    - INPONL22
      Medicare Hospital Summaries, Nationally by DRG for calendar years 1996-1998. Elements contained in this table: DRG Code and Descriptions, Medicare Reimbursement, and Total Days. The DRGs are divided into Surgical, Medical and Other DRG classifications. Choose whether you want your reports ranked by Average Reimbursement per Discharge, Total Medicare Reimbursement, Average Total Days, or DRG.
  - Medicare Hospital Discharge, Long Term Care
    - INPONL31
      Immediate online access to Medicare Hospital Discharges, Nationally by State for calendar years 1994-1998: Elements contained in this table: Total Discharges by Type of Discharge, viz. Home, Death, Institutions, and Other. This table also contains the percentage of each discharge type to national Medicare total discharges.
      View online or download in Excel format.
  - Medicare Hospital Summaries, Long Term Care
    - INPONL32
      Immediate online access to Medicare Hospital Summaries, Nationally by State for calendar years 1995-1998: Elements contained in this table: Number of days by type of Long Term Care facility, viz. Rehabilitation, Christian Science, Psychiatric, Children, etc.
      View them online or download in Excel format.
- Enrollment Statistics
  - HMO Market Penetration by State
    - ENRONL05
      These files provide a graphic representation of the number of HMO enrollees by State. The associated tables of information contain the Total Medicare population by State, the HMO population and the percentage of HMO beneficiaries to the Total population of the State. These tables contain all States for 1994-1998
  - HMO Market Penetration by State by County
    - ENRONL10
      These tables of information contain the Total Medicare population by State and County, the Year-end HMO population, the Total HMO Enrollment per Month and the Total person Months of HMO Enrollment. These tables contain all States.
      Available on-line for CY1994 - 1998
      We have made the table for one state available as an example.
      Note: ALL CELLS LESS THAN 11 HAVE BEEN SUPPRESSED
  - Medicare Enrollment and Entitlement Online
    - ENRONL20
      This table of information contains the Total Medicare population by State and a summary for the year selected, and contain the following information:
      Distribution by race
      Distribution by gender
      Distribution by entitlement, (aged, disabled, ESRD, Part A or Part B, etc.)
      Distribution by age groupings
      Other distributions
      Available on-line for CY1994 - 1998
      We have made the data for one state available as an example.
      Note: ALL CELLS LESS THAN 11 HAVE BEEN SUPPRESSED
- Carrier (Physician Part B) Statistics
  - Nationally by Specialty
    - PTBONL02
      Immediate online access to Medicare Part B Expenditures, Nationally by Specialty Code for calendar years 1996-1999: Elements contained in this table: Total Services, Allowed Services, Submitted Charges, Allowed Charges, Denied Services, Denied Amount, Assigned Services, Payment Amount, and Allowed Charges as a percent of Total Allowed Charges.