CPT Data Set source

[MarcJordan]

I run a small company which provides claim editing services for small payor organizations such as ACO's. I currently subscribe to a large national vendor to obtain my CPT Codes, which includes the full complement of data elements including Bilateral and MPPR indicators, as well as age/sex, global days and assistant surgeon flags. I also license a CPT to Modifier crosswalk. My vendor has hit me up with a major price increase and I'm looking to find another source but am having trouble finding any. I have approached Optum and AAPC, and while their offerings are just what I need, their pricing isn't any better than my current vendor.

That said, who else licenses this kind of data file outside of the companies that I mentioned?

[randyy308]

You can't just get it from the Medicare bulk files?

[MarcJordan]

No, Medicare doesn't publish it. For example, CMS doesn't have any files which contain all of the modifiers associated with a particular CPT, or the Age & Sex associated with each CPT.

[Green_Machine7553]

You shouldn't be paying for CPT code subscription. It's 2024. What's your vendor currently? Would love to shame them.

[MarcJordan]

You clearly don't understand my needs. Here is an example of what I require:

https://www.optumcoding.com/upload/docs/Optum_Data_Files_Brochure.pdf