This supplier of prices provides prices only for CPT/HCPCS codes and a limited number of room and board prices. Due to the nature of the Medicare patient and CMS’ limitations placed on the release of data, the number of prices derived with Medicare claims data for CPT/HCPCS and Room and Board codes is limited. More prices are available for CPT/HCPCS and room and board codes than what is available from Medicare data.
There are also some issues with the Room and Board prices derived Medicare claims data. Depending on the hospital, some of the room and board prices derived from the Medicare data never existed at the hospital. The prices never existed because the hospital has multiple prices for the same revenue code and the vendor providing prices just takes an average of all the units and charges for the revenue code.
Relying only on Medicare claims data also does not allow for the derivation of other categories of prices like anesthesia time, recovery room time and operating room time. However, the prices for these categories of prices are available. Below is a table showing the prices available from Sophical Solutions versus the prices available from Medicare claims data.
