Search the Medicare Physician & Other Practitioners API by Geography and Service

Information on services and procedures provided to Original Medicare (fee-for-service) Part B (Medical Insurance) beneficiaries by physicians and other healthcare professionals; aggregated by geography and service.

Usage

physician_by_geography(
  year,
  level = NULL,
  sublevel = NULL,
  fips = NULL,
  hcpcs_code = NULL,
  hcpcs_desc = NULL,
  hcpcs_drug = NULL,
  place_of_srvc = NULL,
  tidy = TRUE
)

Source

Centers for Medicare & Medicaid Services

Arguments

year: year int (required); Year in YYYY format. Run helper function provider:::physician_by_geography_years() to return a vector of the years currently available.
level: Identifies the level of geography by which the data in the row has been aggregated. A value of 'State' indicates the data in the row is aggregated to a single state identified in the Rendering Provider State column for a given HCPCS Code Level. A value of 'National' indicates the data in the row is aggregated across all states for a given HCPCS Code Level.
sublevel: The state name where the provider is located, as reported in NPPES. The values include the 50 United States, District of Columbia, U.S. territories, Armed Forces areas, Unknown and Foreign Country. Data aggregated at the National level are identified by the word 'National'.
fips: FIPS code of the referring provider state. This variable is blank when reported at the national level.
hcpcs_code: HCPCS code used to identify the specific medical service furnished by the provider.
hcpcs_desc: Description of the HCPCS code for the specific medical service furnished by the provider. HCPCS descriptions associated with CPT codes are consumer friendly descriptions provided by the AMA. CPT Consumer Friendly Descriptors are lay synonyms for CPT descriptors that are intended to help healthcare consumers who are not medical professionals understand clinical procedures on bills and patient portals. CPT Consumer Friendly Descriptors should not be used for clinical coding or documentation. All other descriptions are CMS Level II descriptions provided in long form. Due to variable length restrictions, the CMS Level II descriptions have been truncated to 256 bytes. As a result, the same HCPCS description can be associated with more than one HCPCS code.
hcpcs_drug: Flag that identifies whether the HCPCS code for the specific service furnished by the provider is a HCPCS listed on the Medicare Part B Drug Average Sales Price (ASP) File.
place_of_srvc: Identifies whether the place of service submitted on the claims is a facility (facility) or non-facility (office). Non-facility is generally an office setting; however other entities are included in non-facility.
tidy: Tidy output; default is TRUE.

Value

A tibble containing the search results.

Details

The Geography and Service dataset contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by HCPCS and place of service in the national table and organized by provider state, HCPCS and place of service in the state table. The national and state tables also include a HCPCS drug indicator to identify whether the HCPCS product/service is a drug as defined from the Medicare Part B Drug ASP list.

Note

Update Frequency: Annually

Examples

if (FALSE) { # interactive()
physician_by_geography(hcpcs_code = "0002A", year = 2020)
service <- purrr::map_dfr(as.character(2013:2020),
           ~physician_by_service(npi = 1003000126, year = .x))

procedures <- service |>
              dplyr::distinct(hcpcs_cd) |>
              tibble::deframe()

arg_cross <- purrr::cross_df(list(
             x = as.character(2013:2020),
             y = procedures))

# National Level
purrr::map2_dfr(arg_cross$x, arg_cross$y,
~physician_by_geography(geo_level = "National", year = .x, hcpcs_code = .y))

# State Level
purrr::map2_dfr(arg_cross$x, arg_cross$y,
~physician_by_geography(geo_level = "Georgia", year = .x, hcpcs_code = .y))
}