UCLA Biodesign Program Resources

Coding

• Current Procedural Terminology (CPT) Codes.
  CPT is used to report medical procedures and services to federal and private payers for reimbursements.

  • Current Procedure Codes with RVUs (2022). 
    Timely, accurate, and value-added info to power coding, billing and practice management systems, from Optum360. Essential coding and reimbursement data for the CPT® code.

  • CPT Code/Relative Value Search 
    AMA page to perform CPT code searches and obtain Medicare's relative value payment amount associated with a code. Perform searches using 5 digit CPT code number or key word(s) in the code description. Sign-in required (account is free).
     

• Diagnostic and Statistical Manual (DSM-5) Coding. 
  The DSM is a classification of current mental disorders with associated criteria.

• Diagnosis-Related Group (DRG) Coding.
  Patient classification system that standardizes prospective payment to hospitals. A DRG payment covers all charges associated with inpatient stay, from admission to discharge.

• Healthcare Common Procedure Coding System (HCPCS) Codes.
  Collection of standardized codes of medical procedures, supplies, products and services used to facilitate health insurance claims processing by Medicare and other insurers.

  • Alpha-Numeric HCPCS Codes, from the CMS.
     

• WHO International Classification of Diseases, ICD. A World Health Organization standardized tool for healthcare classification. Provides a diagnostic codes system for classifying generic and specific diseases in countries. 

• ICD-11. Foundation to identify health trends and statistics globally; international standard for reporting diseases and health conditions. The diagnostic classification standard for all clinical and research purposes.
• International Classification of Functioning, Disability and Health (ICF). WHO tool to classify health and health-related domains; includes environmental factors.

• WHO Nomenclature of Medical Devices. WHO's various nomenclature systems used to code generically identifiable medical devices and health products.

Pricing
Procedures & Prescription Drugs

• Clear Health Costs. 
  Lists prices for medical procedures by geographical location.

• GoodRx. 
  List prices (ASP) for prescription drugs from over 60K U.S. pharmacies.

• Guroo. 
  Database of national, state, and local cost and quality info for common health conditions and services.

• Haiweb. 
  Sources for national drug prices (indicates type of price info) for many countries worldwide.

• MICROMEDEX Healthcare Series. 
  Contents: Dosing and therapeutic tools -- DRUGDEX -- DRUG-REAX -- IDENTIDEX -- IV index -- Martindale Pharmacopaeia -- CareNotes -- USP MSDS -- Drug consults -- TOMES system -- Reprorisk. Martindale: The Complete Drug Reference -- Material Safety Data Sheets (MSDS) from USP DI -- Physicians' Desk Reference -- Red Book -- REPRORISK

• National Average Drug Acquisition Cost (NADAC). 
  Medicaid database with national average drug acquisition cost (WAC price/unit); historical data from Nov 2013-present.

Reimbursement

DRG Fingertip Formulary. 
Reimbursement policies for specific drugs at specific insurance providers (with formulary tier, prior authorization, step therapy requirements).

Medi-Cal Reimbursement Rates.
Medi-Cal is California's Medicaid health care program. Site contains Medi-Cal fee-for-service rates listed by procedure code, and includes procedure descriptions, unit values, basic and child rates, and more.

Medicare Physician Fee Schedule (PFS). 
Look-up tool: Payment rate, relative value, and policy info for services covered by Medicare.

Utilization

Agency for Healthcare Research & Quality, AHRQ.
Evidence-based info on healthcare outcomes, quality, cost, use, access. Note: Gain access to longitudinal data re patient interactions with healthcare system, with all transactions and their codes (indicating procedures, diagnosis), plus service location to help develop market segments. 

Healthcare Cost and Utilization Project (HCUPnet). 
Online query system of health statistics and info on hospital inpatient stays, readmissions and emergency dept utilization at national, regional, state levels.

Medical Expenditure Panel Survey (MEPS). 
Longitudinal datasets on healthcare expenditures of U.S. families, individuals, medical providers, insurers/employers; "the only and most complete national data source measuring how Americans use and pay for medical care, health insurance, and out-of-pocket spending." Note: Useful for detailed analysis of market segments, sizing; can be labor intensive. Available for conditions with 1% prevalence rate or greater.

​National Healthcare Quality and Disparities Reports, annual, 2007-present.

Medicare Provider Utilization and Payment Data.
Public data set summarizing utilization and payments for procedures and services to Medicare fee-for-service beneficiaries by specific inpatient or outpatient hospitals, physicians, other suppliers; has 100 most common inpatient services, 30 common outpatient services, all physician and other supplier procedures/services performed on 11+ Medicare beneficiaries.