Medicare
Find CMS-certified hospitals and calculate what Medicare pays them for DRG, APC and CPT items.
Free reference tools over the CMS payment files. Every number is a Medicare payment estimate, not what a commercial insurer pays; use it as the yardstick for "percent of Medicare".
find_medicare_hospitals
Finds a hospital's CCN (CMS Certification Number) and its wage index.
| Parameter | Type | Default | What it does |
|---|---|---|---|
limit | integer | 25 | Most rows to return. Each tool has its own cap. On a free plan, paid data returns 8 rows whatever you ask for. |
q | string | none | Search the service description, up to 200 characters. |
state | string | none | Two-letter US state, for example FL. A state on its own is not enough: add codes, apc, q or hospital_ids. |
Each row has ccn, provider_name, state, cbsa (the CMS wage-index metro, which can differ from find_hospitals' metro), wage_index and year, all snake_case.
calculate_medicare_rates
What Medicare pays one hospital for MS-DRG, APC or CPT items, optionally at a percent of Medicare.
| Parameter | Type | Default | What it does |
|---|---|---|---|
apply_sequestration | boolean | true | Take off the 2% Medicare sequestration cut. |
ccn | string | required | CMS Certification Number: the 6-digit id of a Medicare-certified hospital. |
items | list of object | required | Up to 50 things to price: each has a type (drg, apc or cpt), a code and optionally a modifier. |
percent_of_medicare | number | 1 | Scale the Medicare rate to this percent. 100 is Medicare itself. |
site | facility | non_facility | facility | Where the service is given, for CPT items. |
year | integer | none | Data year. |
items is up to 50 entries like {"type": "drg", "code": "470"}, {"type": "apc", "code": "5301"} or {"type": "cpt", "code": "99213"}. percent_of_medicare is a multiplier (1.0 is 100%, 2.5 is 250%, at most 5). With no year, each item type uses the newest year that has data for it, and years says which (for example {"drg": 2026, "cpt": 2026}). The answer has results (expected_payment and its components per item), unresolved (items it could not price, with a reason) and assumptions (site of service, sequestration, outliers excluded).
Example questions
- What does Medicare pay Tampa General for DRG 470?
- What would 250% of Medicare be for a 99213 at Grady?
- Which hospitals in Georgia have the highest Medicare wage index?