Nebraska Medical Pricing

Billing code: A short identifier for a specific medical service, drug, or hospital stay. The columns below name the families these codes come from.
NPI: National Provider Identifier — a 10-digit number that uniquely identifies a doctor, clinic, or hospital.
TIN: Taxpayer Identification Number (an EIN) — the tax ID of the legal entity that bills for the service, usually the parent practice or hospital system.
× Medicare: How the negotiated rate compares to what Medicare would pay nationally for the same service. 1.5× means the commercial price is 50% higher than Medicare.

Professional (MPFS): The Medicare Physician Fee Schedule — what Medicare pays a doctor for a service done in a regular office or clinic.
Hospital Outpatient (OPPS): The Outpatient Prospective Payment System — what Medicare pays a hospital for outpatient procedures (e.g. an MRI or same-day surgery you go home from).
Ambulatory Surgical Center (ASC): What Medicare pays a free-standing surgery center for procedures that don't require an overnight stay.
Inpatient (MS-DRG): The Medicare-Severity DRG schedule — one lump payment to a hospital for an admitted-overnight stay, set by the patient's diagnosis grouping.

CPT: Current Procedural Terminology — 5-digit codes for procedures and physician services (e.g. 27130 = total hip replacement). Owned by the AMA.
HCPCS: Healthcare Common Procedure Coding System Level II — alphanumeric codes for drugs, devices, and services not covered by CPT (e.g. J1100 = a specific injectable drug).
RC: Revenue Code — 4-digit billing categories on hospital claims (e.g. 0300 = lab, 0450 = ER, 0610 = MRI). Tells the payer which department the charge came from, not what was done.
MS-DRG: Medicare Severity Diagnosis-Related Group — Medicare's bucket for an inpatient hospital stay (e.g. DRG 470 = major joint replacement). One DRG = one lump payment per admission.
APR-DRG: All-Patient Refined DRG — a different inpatient grouper used by some commercial payers and state Medicaid programs. Not directly comparable to Medicare's MS-DRG.
CSTM-ALL: A payer-specific "custom" tag. BCBSNE uses CSTM-00 to mark fees that apply across every place of service rather than just one.

Summary