MC_PRICER_SUMMARY

Description: |
This table contains pricing summary output returned by the Epic Pricer.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
PRICER_MSG_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | PRICER_MSG_ID | NUMERIC | No |
The unique identifier for the Pricer Message record.
2 | PRICE_SUM_ALLOW | NUMERIC | No |
Returned allowed amount from pricing summary data.
3 | PRICE_SUM_PMT | NUMERIC | No |
Returned payment amount from pricing summary data. This is a calculation of the allowed amount minus coinsurance/deductible.
4 | PRICE_SUM_DEDUCT | NUMERIC | No |
Returned deductible amount from pricing summary data.
5 | PRICE_SUM_COINS | NUMERIC | No |
Returned coinsurance amount from pricing summary data.
6 | PRICE_SUM_OUTLIER | NUMERIC | No |
Returned outlier amount from pricing summary data.
7 | PRICE_SUM_HCPCS_RTN_C_NAME | VARCHAR | No |
The returned HCPCS Pricer return code from pricing summary data.
May contain organization-specific values: No
Category Entries:
Priced Normally
Review Needed for Co-Surgeon
Review Needed for Assistant At Surgery
Not Covered
Paid in Other Services
Missing HCPCS Code
Fee Schedule Amount is 0
Priced by Percentage of Billed
Priced by Percentage of Cost
Reporting Purposes
Review Needed for Anesthesiologist Present at Induction During Supervision
HCPCS Code Not Found in Fee Schedule
HCPCS and POS Type Do Not Match
Missing Required Modifier
Missing Ambulance Pickup Zipcode
Missing Anesthesia Time in Minutes
Service Date Prior to HCPCS Effective Date
Team Surgeon Distribution Required
More Than 5 Surgeries
Missing Physician
Invalid Units for Bilateral Codes
Invalid Modifiers
CBSA Not Found
Wage Index Not Found
NOC Not Found for NDC
Price by Medicare Contractor Review
Service Date After Effective End Date
Generic bad request
8 | PRICE_SUM_FSC_AMT | NUMERIC | No |
Returned fee schedule amount from pricing summary data.
9 | IS_NON_FACILITY_RATE_YN | VARCHAR | No |
Indicator for whether the service is paid using the non-facility rate in the Medicare Physician Fee Schedule.
May contain organization-specific values: No
Category Entries:
No
Yes
10 | ALLOWED_AMT_BEFORE_ADJ | NUMERIC | No |
Medicare fee schedule allowed amount before any pricing adjustments.
11 | UNITS_APPLIED | NUMERIC | No |
Number of units applied to the base fee schedule rate to determine the Medicare allowed amount.
12 | PRICE_SUM_CLAIM_DRG | VARCHAR | No |
The DRG code used by the Epic Pricer to price a claim.