Review pricing intelligence surfaces
This page keeps the pricing family in one place: fee drift, RVU-rate divergence,
OPPS payment bands, and CLFS variance atlas. Use these as planning context before local validation.
PFS codes: 9,679
OPPS APC bands: 902
CLFS families: 25
Source snapshot: cms.pfs.2026@2026-03-31T18:58:47.492Z · Schema: intelligence.pricing.fee-drift.v1
O1 · CPT Fee Drift Heatmap
Compare facility versus non-facility PFS baselines to spot where site-of-service assumptions can distort reviews.
Observed support
Coverage 100.00%
Join success 100.00%
PFS fee schedule rows meet full support thresholds for this view.
Support: 19,277 of 19,277 entities met support thresholds.
Snapshot cms.pfs.2026@2026-03-31T18:58:47.492Z · Schema intelligence.pricing.fee-drift.v1 · Generated 4/6/2026
Relative drift between national facility and non-facility PFS rates.
Required fields present: facility RVU, non-facility RVU, conversion factor National fee schedule coverage available for all included codes Medicare PFS context only; not commercial contract adjudication. Rate drift does not explain local payer policy or documentation quality. Select a code to keep the chart in place while the review panel updates. The URL saves the selection so you can share the same comparison state.
Compare two measures Select a row to keep the chart in view while details update.
Horizontal bar chart comparing Facility rate and Non-facility rate across 12 categories. 12 categories compared across Facility rate and Non-facility rate. 37294 has the highest facility rate at 813.98. 37277 has the highest non-facility rate at 15,420.86. Facility rate and Non-facility rate comparison table Category Facility rate Non-facility rate 37277 681.71 15,420.86 37294 813.98 15,198.75 27278 439.22 13,754.82 37273 576.17 13,228.43 37269 674.7 11,553.37 37271 411.5 10,562.7 37275 501.35 10,275.79 37286 618.92 10,365.97 55882 527.73 9,636.16 55881 429.54 9,270.42 36837 400.81 9,092.73 36836 313.63 8,032.92
Rvsc evsc fpvt st athr cpx 1
Facility baseline $681.71
Non-facility baseline $15,420.86
Absolute gap $14,739.15
Payment status A non-facility setting is 2162.1% above the other baseline
Use this locked view when you want to compare one code without losing the rest of the chart context or jumping farther down the page.
Top code by absolute drift: 0446T (12860.27%).
O2 · RVU-to-Rate Divergence
Detect codes where RVU intensity and non-facility reimbursement deviate from the median relationship.
Observed support
Coverage 100.00%
Join success 100.00%
Work RVU and non-facility rate relationship is complete for the supported code universe.
Support: 19,277 of 19,277 entities met support thresholds.
Snapshot cms.pfs.2026@2026-03-31T18:58:47.492Z · Schema intelligence.pricing.rvu-rate-divergence.v1 · Generated 4/6/2026
Codes where work RVU intensity and national non-facility rates diverge from the median relationship.
Work RVU and non-facility rate must both be present Expected-rate baseline uses complete observed code set Uses national PFS context and does not represent local payer fee schedules. Divergence is a planning signal, not an adjudication or compliance determination. Distribution + intensity Bubble size represents weighted context volume.
Bubble chart plotting Work RVU against Non-facility rate ($) for 40 points. Bubble size represents weighted context volume. 40 bubble points shown. 37277 has the highest work rvu at 15. 37277 has the highest non-facility rate ($) at 15,420.86. Work RVU and Non-facility rate ($) bubble chart table Label Work RVU Non-facility rate ($) Bubble size 0446T 1.11 6,320.12 1,397.653 0448T 1.86 6,219.58 813.937 33285 1.49 4,012.12 652.188 95149 0.06 118.57 474.22 G2083 0.7 1,356.08 464.54 27278 7.66 13,754.82 429.372 52443 3.62 5,904.28 388.472 65778 0.82 1,274.24 369.33 95148 0.06 89.18 352.535 36516 1.52 2,227.84 347.403 G2082 0.7 952.59 321.363 55874 2.95 3,704.49 295.26 75580 0.73 886.79 285.082 75577 0.85 1,012.05 279.085 37271 9 10,562.7 274.86 37279 4 4,636.04 271.228 36836 7.02 8,032.92 267.572 37262 3 3,409.23 265.613 19296 3.54 3,993.41 263.545 91111 0.88 956.94 253.447 37273 12.63 13,228.43 243.498 95146 0.06 62.46 241.913 37277 15 15,420.86 238.698 96425 0.17 174.02 237.602 53865 3.02 3,086.58 237.205 97610 0.39 397.47 236.488 36837 9.07 9,092.73 232.352 95147 0.06 60.12 232.233 37287 5 4,940.33 228.765 30469 2.38 2,322.7 225.75 55881 9.56 9,270.42 224.205 91132 0.51 485.65 219.87 G0138 0.21 196.4 215.64 37275 11 10,275.79 215.377 97607 0.4 367.41 211.492 31242 2.63 2,395.51 209.583 45346 2.74 2,492.38 209.282 37268 3.73 3,360.13 207.098 52284 3.02 2,682.76 203.992 31243 2.63 2,326.04 203.022
Review emphasis uses p90 divergence threshold (167.57%).
O3 · Global Surgery Mix View
Split procedural mix by global-period band and compare routine versus higher-complexity concentration.
Derived support
Coverage 43.43%
Join success 43.43%
Global-period coverage is strong enough for planning context but not complete enough for observed classification.
Support: 8,372 of 19,277 entities met support thresholds.
Snapshot cms.pfs.2026@2026-03-31T18:58:47.492Z · Schema intelligence.pricing.global-surgery-mix.v1 · Generated 4/6/2026
Distribution of PFS code mix across global-period bands with a complexity split.
Required fields: globalDays, workRVU, nonFacility RVU, conversionFactor Observed threshold: >= 85% support coverage Uses Medicare global-period indicators and national rates only. Does not include local payer modifiers or claim-level adjudication context.
Composition by category
Stacked horizontal bar chart showing Higher complexity cohort and Routine cohort by category. 7 categories shown with stacked values for Higher complexity cohort and Routine cohort. 90-day major has the highest combined total at 3,761. Higher complexity cohort and Routine cohort stacked share table Category Higher complexity cohort Routine cohort Total 90-day major 3,528 233 3,761 No global/bundled 65 2,251 2,316 0-day procedural 378 879 1,257 Related service window 110 445 555 10-day minor 98 367 465 Maternity global 14 3 17 Carrier-defined global 1 0 1
Surgical codes tracked: 4,226 · Major-surgery band: 3,761.
O4 · Modifier Sensitivity Matrix
Use status-code groupings as a deterministic proxy for where modifier-sensitive review queues concentrate.
Derived support
Coverage 50.21%
Join success 50.21%
Modifier sensitivity proxy has enough support for planning context but remains incomplete for observed classification.
Support: 9,679 of 19,277 entities met support thresholds.
Snapshot cms.pfs.2026@2026-03-31T18:58:47.492Z · Schema intelligence.pricing.modifier-sensitivity-proxy.v1 · Generated 4/6/2026
Status-code group sensitivity proxy based on facility/non-facility drift concentration.
Required fields: facility RVU, nonFacility RVU, conversionFactor Observed threshold: >= 85% support coverage This is a derived proxy and does not directly measure modifier-field behavior. Use for planning sequence only; validate with local modifier audits before conclusions.
Composition by category
Stacked horizontal bar chart showing Review-priority proxy and Baseline proxy by category. 7 categories shown with stacked values for Review-priority proxy and Baseline proxy. A has the highest combined total at 9,409. Review-priority proxy and Baseline proxy stacked share table Category Review-priority proxy Baseline proxy Total A 935 8,474 9,409 R 15 89 104 N 12 45 57 B 3 35 38 X 2 12 14 T 1 7 8 I 0 49 49
Review threshold (p90 absolute drift): 88.48%.
O5 · OPPS APC Payment Bands
Group outpatient rates by APC to locate high-density payment bands before deep code-level review.
Observed support
Coverage 100.00%
Join success 100.00%
OPPS APC grouping coverage is complete for active payment-rate rows.
Support: 18,986 of 18,986 entities met support thresholds.
Snapshot cms.opps.2026@2026-03-31T18:58:47.678Z · Schema intelligence.pricing.opps-apc-bands.v1 · Generated 4/6/2026
APC-level OPPS payment bands derived from grouped national outpatient rates.
APC and payment-rate fields must be present Status-indicator coverage required for grouped output National OPPS rates only; local contract terms and payer edits are not included. Banding is for prioritization, not claim-level payment prediction.
Compare two measures
Horizontal bar chart comparing Median payment and P90 payment across 12 categories. 12 categories compared across Median payment and P90 payment. 0845 has the highest median payment at 4,505,000. 0845 has the highest p90 payment at 4,505,000. Median payment and P90 payment comparison table Category Median payment P90 payment 0845 4,505,000 4,505,000 9138 3,685,266.67 3,685,266.67 0908 3,335,820 3,335,820 0714 3,327,859.73 3,327,859.73 0748 3,252,508.08 3,252,508.08 0906 3,180,000 3,180,000 0746 2,939,968.89 2,939,968.89 9141 2,588,981.23 2,588,981.23 0824 2,332,000 2,332,000 2067 770,620 770,620 9498 587,649.57 587,649.57 9194 566,531.3 566,531.3
O6 · CLFS Variance Atlas
Compare rate concentration across CLFS families and identify where gap-fill behavior concentrates.
Observed support
Coverage 100.00%
Join success 100.00%
CLFS family grouping and national-limit comparisons meet observed support thresholds.
Support: 2,038 of 2,038 entities met support thresholds.
Snapshot cms.clfs.2026q1@2026-03-31T18:58:47.750Z · Schema intelligence.pricing.clfs-variance-atlas.v1 · Generated 4/6/2026
CLFS code-family concentration and rate variance against national limit references.
Rate and national-limit values required for each included code Family-level grouping must meet minimum row support National CLFS context only; regional lab contracts and local utilization mix are out of scope. Family-level variance is descriptive and not a coverage determination. Distribution + intensity Bubble size represents weighted context volume.
Bubble chart plotting Median family rate ($) against Average variance (%) for 25 points. Bubble size represents weighted context volume. 25 bubble points shown. 03 has the highest median family rate ($) at 797.45. 81 has the highest average variance (%) at 0. Median family rate ($) and Average variance (%) bubble chart table Label Median family rate ($) Average variance (%) Bubble size 81 255.05 0 26.333 87 22.75 0 19.917 86 14.05 0 18.583 82 15.45 0 14.75 84 13.72 0 10.667 83 16.67 0 8.833 85 9.72 0 8 02 720 0 8 04 760 0 7.833 00 450.91 0 7.667 80 18.64 0 7.5 03 797.45 0 7 05 473.91 0 6.667 01 356.13 0 6.5 88 27.64 0 5 G0 26.49 0 5 89 8.61 0 5 P2 4.95 0 5 Q0 9.74 0 5 78 11.06 0 5 P9 9.34 0 5 U0 35.92 0 5 36 9.34 0 5 G9 120.72 0 5 P3 18.54 0 5
Have a medical bill?
Upload it and check line items against Medicare benchmarks, NCCI bundling rules, and pricing data.
Open Bill Analyzer
Boundary Relative drift between national facility and non-facility PFS rates.
Helps teams spot where site-of-service assumptions can distort baseline comparisons.
Medicare PFS context only; not commercial contract adjudication. Rate drift does not explain local payer policy or documentation quality.