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Medicare Advantage, Part D, Medicaid

CMS PFS Payment-Policy Indicators (PPRRVU)

medicare_silver.medicare_pfs_indicators·live·silver

Rows

19,356

Columns

24

History

N/A

Card

nocolumns only

Typed tools

0

What it is

1Per HCPCS x modifier, the payment-policy indicators from the CMS PFS Relative Value File (PPRRVU) that the National Physician Fee Schedule pricing files drop: status_code (A/B/N/X...), global_period (000/010/090/XXX...), pctc_ind (PC/TC split), mult_proc_ind (the multiple-procedure reduction rule: 2=standard surgical MPPR 100/50/50, 3=endoscopy, 4=imaging, 5=therapy, 9=n/a), and bilat_ind (the bilateral rule: 1=150% adjustment applies).
2Used by the claims-repricing engine to apply the multiple-procedure reduction and bilateral adjustment so professional claims aren't paid in full where Medicare reduces.
3Quarterly CMS release (2026, rvu26c).

Grain

Key	Grain
N/A	1One row per HCPCS x modifier from the CMS PFS Relative Value File — the status / global / PC-TC / multiple-procedure / bilateral indicators.

Columns (24)

Column	Type	Meaning
`year`	int
`row_seq`	bigint
`hcpcs`	string
`modifier`	string
`status_code`	string
`pctc_ind`	string
`global_period`	string
`mult_proc_ind`	string
`bilat_ind`	string
`observed_period`	date
`asserted_at`	date
`effective_period_start`	date
`effective_period_end`	date
`cms_vintage_sequence`	int
`parse_revision`	int
`parser_artifact_hash`	string
`source_url`	string
`sha256_content_hash`	string
`source_id`	string
`is_current`	boolean
`bronze_object_key`	string
`s3_version_id`	string
`vintage_tag`	string
`drug_source_version_id`	string

Query it

describe_data_source(source_fqn="medicare_silver.medicare_pfs_indicators")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.medicare_pfs_indicators WHERE <filter> LIMIT 100")

Item	Value
Typed tools that read it	none; raw SQL
Identity key	`hcpcs`
Join	`how_to_join(source_fqn="medicare_silver.medicare_pfs_indicators")`
Raw door	Athena (read-only via query_substrate): medicare_silver.medicare_pfs_indicators
Note	Iceberg table medicare_silver.medicare_pfs_indicators, partitioned by year. Parsed by stable PPRRVU column position (the multi-row header has ambiguous names). The pricer queries it per-book (codes present only).

This page as markdown: /docs-md/data/medicare_silver_medicare_pfs_indicators.md · every page in one file: /llms-full.txt