MC_PRICER_METADATA

Description: |
This table contains a variety of metadata returned from 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 Epic Pricer message record.
2 | MC_PRICER_TYPE_C_NAME | VARCHAR | No |
The pricer type calculated by the Epic Pricer.
May contain organization-specific values: No
Category Entries:
Outpatient PPS
Inpatient PPS
Multi-Pricer
Home Health Agency
Ambulatory Surgery Center
End Stage Renal Disease
Skilled Nursing Facility
Inpatient Psychiatric Facility
Inpatient Rehabilitation Facility
Long Term Care
Critical Access Hospital - Outpatient
Critical Access Hospital - Inpatient
All Patient Refined DRG
Medicare Severity DRG
Ambulatory Patient Group
External PPS Pricer
Federally Qualified Health Center
Hospice
Fee Schedule
Physician
Anesthesia
Durable Medical Equipment, Prosthetics/Orthotics & Supplies
Drugs and Biologicals
Laboratory Services
Ambulance
Cost Based
Rural Health Center
Comprehensive Outpatient Rehabilitation Facility
Opioid Treatment Program
Home Infusion Therapy
Medicare Diabetes Prevention Program
Vaccine
Radiopharmaceutical
Medicare Contractor Priced Codes
3 | PRICER_RETURN_CODE | VARCHAR | No |
The return code returned from the Epic Pricer.
4 | PRICER_PROV_CCN | VARCHAR | No |
The CMS Certified Numer (CCN) used when the Epic Pricer was invoked.
5 | PRICER_CCN_EFF_DATE | DATETIME | No |
The effective date associated with the CCN in column PRICER_PROV_CCN for the Epic Pricer.
6 | MC_PRICER_PROV_TYPE_C_NAME | VARCHAR | No |
The Instituional provider type defined by CMS.
May contain organization-specific values: No
Category Entries:
Short Term Facility
Long Term
Psychiatric
Rehabilitation Facility
Pediatric
Hospital Distinct Parts (Deprecated)
Rural Referral Center
Indian Health Service
Cancer Facility
Medicare Dependent Hospital (Deprecated)
Medicare Dependent Hospital/Referral Center (Deprecated)
Re-based Sole Community Hospital
Re-based Sole Community Hospital/ Referral Center
Medical Assistance Facility
Essential Access Community Hospital
Essential Access Community Hospital/Referral Center
Rural Primary Care Hospital
Nursing Home Case Mix Quality Demo Project - Phase II
Nursing Home Case Mix Quality Demo Project - Phase III - Step 1
Reserved
Hospice
Home Health Agency
Critical Access Hospital
Skilled Nursing Facility (SNF) - For non-demo PPS SNFs
Hospital Based ESRD Facility
Independent ESRD Facility
Federally Qualified Health Centers
Religious Non-Medical Health Care Institutions
Rural Health Clinics-Free Standing
Rural Health Clinics-Provider Based
Comprehensive Outpatient Rehab Facilities
Community Mental Health Centers
Outpatient Physical Therapy Services
Psychiatric Distinct Part
Rehabilitation Distinct Part
Short-Term Hospital - Swing Bed
Long-Term Care Hospital - Swing Bed
Rehabilitation Facility - Swing Bed
Critical Access Hospital - Swing Bed
7 | MPFS_STATUS_INDICATOR_C_NAME | VARCHAR | No |
The status indicator returned for a service priced using a physician fee schedule. The released values are extracted from the CMS Medicare physician fee schedule and are owned by CMS.
May contain organization-specific values: No
Category Entries:
Active code
Bundled code
Contractor priced code
Deleted code
Excluded from fee schedule by regulation
Deleted modifier
Not valid for Medicare
Anesthesia service
Local code
Measurement code
Non-covered service
Bundled/excluded code
Restricted coverage
Injection
Statutory exclusion
Unknown
8 | ASC_PAYMENT_INDICATOR_C_NAME | VARCHAR | No |
The payment indicator returned for a service priced using an ASC fee schedule. The released values are extracted from the CMS ASC fee schedule and are owned by CMS.
May contain organization-specific values: No
Category Entries:
Surgical procedure; payment based on OPPS relative payment weight
Alternative code may be available; no payment made
Inpatient surgical procedure under OPPS; no payment made
Ancillary dental service/item: no separate payment made
Non-office based dental procedure added in CY2024 and later
Deleted/discontinued code; no payment made
Surgical Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made
Corneal tissue acquisition, hepatitis B vaccine; paid at reasonable cost
Non-office based surgical procedure; payment based on OPPS relative payment weight
Brachytherapy source paid separately; payment based on OPPS rate
Brachytherapy source paid separately; payment contractor-priced
Device-intensive procedure; paid at adjusted rate (OBSOLETE)
OPPS pass-through device paid separately; payment contractor-priced
Device-intensive procedure; paid at adjusted rate
Drugs and biologicals paid separately; payment based on OPPS rate
Items, codes, and services for which pricing information and claims data are not available; No payment made
Unclassified drugs and biologicals; payment contractor-priced
Influenza vaccine; pneumococcal vaccine; Packaged item/service; no separate payment made
New Technology Intraocular Lens (NTIOL); special payment
No payment made; paid under another fee schedule
Packaged service/item; no separate payment made
Office-based surgical procedure with Medicare Physician Fee Schedule nonfacility practice expense relative value units; payment based on OPPS relative payment weight
Office-based surgical procedure with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs
Office-based surgical procedure without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight
Service not surgical in nature; and not a radiology service payable under the OPPS, drug/biological, or brachytherapy source. Packaged item/service; no separate payment made
Surgical unlisted service excluded from ASC payment. No payment made
Unsafe surgical procedure in ASC. No payment made
Non-Surgical Procedure/item not valid for Medicare purposes because of coverage, regulation and/or statute; no payment made
Radiology service paid separately; payment based on OPPS relative payment weight
Radiology service paid separately; payment based on MPFS nonfacility PE RVUs
Unknown