Financial incentives are often an important driver of people's actions. I want to better understand how different medical procedures get reimbursed in the US by medicare. Unfortunately I couldn't find the price list via Google myself.

Is there a public website that lists the amount that doctors get reimbursed for various procedures?

1 Answer 1


From cms.gov

One important factor in these calculations seems to be the RVU, or Relative Value Unit.

The real calculation I found is here, near the bottom of the page. Search for [physician fee schedule medicare] for other sources. You may need this if you find data in other files. It looks like you have your work cut out for you. You have to find files for each part of the equation as it appears. Through my poking around for 2-3 hours, there is a base number, then each hospital has a factor that is multiplied by the base number. (Not sure what the factor is about but each hospital receives ratings for the Medicare program, so the factor may be about higher ratings = higher reimbursement.)

This link appears to be a general entry point for how to calculate reimbursement rates.

On this page there is a zip file called relative value file which has the value for HCPCS codes, which appears to be the code for each procedure.

This zip file "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/CY2015-PFS-FR-Direct-PE-Inputs.zip" contains a file called "Deliverable PUF_labor_detail_FR2015CN 20150102.xls" which has the value per minute (rate_per_minute, Col D) of many HCPCS codes. That is for labor codes only. IN the same zip file there is "Deliverable PUF_supplies_DetailFR2015CN 20150102.xls" which has reimbursement rates for usable supplies, like gauze, rubber gloves used during surgery, etc. There is another SS with a similar name, replace "supplies" in the filename with "equipment". That looks like durable equipment.

At the bottom of https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/physicianfeesched/ is a section called Related Links. The link "HCPCS level file" (a zip file) might also help you. There is also a link for "Example Calcuation File", which probably requires data from other spreadsheets to calculate the rate for your hospital.

Double check calculations

To double check your calculations go to Physicians Fee Schedule Look Up Tool

Other sources

Here is a zip file from Data.medicare.gov. The CSV is inside a zip file. The data dictionary is in the zip file as "hospital.pdf". In other CSV files in this file it appears a hospital is given a factor, which is multiplied by the base reimbursement amount, and that number is the amount the hospital is reimbursed for that procedure.

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