Our Data & Methodology
How PayerReady sources, validates, and continuously updates one of the largest privately-maintained RCM reference datasets outside a clearinghouse. Every number on this site traces to a CMS, AMA, CDC, or X12 source you can verify yourself.
Reference row counts
Live counts from our production database. Updated nightly against upstream source releases.
Where every number on this site comes from
CMS, AMA, CDC, X12, and CMS NPPES are the only first-source publishers we use. We never invent fees, never hallucinate codes, never paraphrase clinical descriptors.
CPT Procedure Codes
CPT code numbers and short descriptors from CMS Physician Fee Schedule. Long descriptors are AMA copyright and not redistributed; PayerReady publishes our own billing guidance instead.
ICD-10-CM Diagnoses
Complete CDC tabular list with chapter/section hierarchy, Excludes1/Excludes2 notes, Includes/Code First/Use Additional Code annotations, billable flags, and HCC v28 mapping.
ICD-10-PCS Procedures
Inpatient procedure coding for hospital UB-04 claims. Used in MS-DRG assignment.
HCPCS Level II
Drug J-codes, DME, supplies, ambulance origin/destination, dental D-codes (CDT), commercial S-codes, Medicaid T-codes. Includes NDC linkage on drug codes.
NCCI PTP Bundling Edits
Procedure-to-procedure bundling pairs with modifier indicator (0 = absolute, 1 = bypassable with documentation). Powers our auto-bundling-trap detection on every CPT page.
Medicare Physician Fee Schedule
Locality-adjusted fee schedule across all 55 Medicare Administrative Contractor (MAC) jurisdictions. Facility and non-facility rates per CPT.
NCCI Medically Unlikely Edits
Per-day maximum unit limits for each CPT/HCPCS, with MAI rationale (1=line, 2=date-of-service, 3=date-of-service appealable). Surfaces on every code detail page.
CARC + RARC Denial Codes
Standard EOB and 835 ERA adjustment reason codes with claim group classification (CO, PR, OA, PI, PM). Augmented with PayerReady curated root-cause analysis and appeal letter templates for top denials.
NPPES Provider Registry
National Provider Identifier dataset with primary taxonomy, practice address, phone, and group affiliations. Powers the user-initiated NPI Lookup Tool only. We do not publish per-provider pages.
NDC Drug Database
NDC linked to HCPCS J-codes for drug billing, with package sizes and dosage forms. Surfaces on J-code pages with NDC reporting requirements per payer.
MS-DRG Inpatient Groupers
Medicare Severity Diagnosis Related Groups for inpatient hospital reimbursement. Includes CC and MCC mapping, geometric mean LOS, relative weights.
APC Outpatient Groupers
Ambulatory Payment Classifications for hospital outpatient reimbursement under OPPS. Includes status indicators, payment rates, packaging flags.
From CMS source file to your screen
Every code, fee, and bundling pair on PayerReady passes through this 4-stage pipeline before it's published.
Ingest from source
Automated nightly pulls from CMS, AMA, CDC, X12, and FDA. SHA-256 checksums on every download. New release triggers full re-import, never partial overwrites.
Validate & cross-link
Rules engine (163/163 accuracy tests passing) cross-references CPT to NCCI, CPT to MUE, CPT to MPFS rates, ICD-10 to HCC, denial code to CPT pairings. Anomalies are flagged, not silently corrected.
Specialist review
PayerReady Medical Coding Team spot-checks a rolling sample of 500 pages per month. Specialist authors prose blocks (modifier guidance, bundling rationale, payer notes) for the top-traffic codes.
Indexability gate
Pages that fail the minimum-data check (no MPFS rate, no NCCI partners, no cross-references) are marked noindex and excluded from sitemaps. We refuse to publish thin pages just to pad URL counts.
PayerReady vs typical free code references
Most free reference sites republish CMS files. We pair the raw codes with the bundling, fee, and denial context billers actually need.
| Capability | PayerReady | Typical free reference |
|---|---|---|
| CPT short descriptors | ||
| ICD-10-CM full tabular hierarchy | ||
| Medicare fee schedule per MAC (55 jurisdictions) | ||
| NCCI bundling partners (4.5M edits) | ||
| MUE per-day quantity limits | ||
| HCC v28 risk-adjustment mapping | ||
| Specialty billing guides with revenue tips | ||
| CARC denial appeal templates | ||
| LCD coverage flags per code | ||
| Inline glossary linker for billing terms | ||
| Last-verified timestamp on every page | ||
| No paywall, no signup required |
What we deliberately don't publish
We could pad our URL count by orders of magnitude. We don't, because the resulting pages would either violate copyright, harm individual privacy, or mislead billers with unverified data.
Copyright AMA. We publish code numbers + short descriptors + our own coding guidance instead.
Our 9.5M NPI dataset powers the user-initiated NPI Lookup Tool only. We do not publish 9.5M individual provider URLs.
Our fee figures are CMS Medicare and clearly labeled. We don't publish contracted commercial rates we cannot source publicly.
Find an error? We fix it within 10 days.
Every code page carries a "Last verified" timestamp. If you spot a mistake, wrong descriptor, outdated fee, missing modifier, email our coding team. We review every report within 5 business days and publish a correction within 10 if confirmed.
coding@payerready.comBuilt on the same data clearinghouses use.
PayerReady credentialing customers get the full coding toolkit, denial library, specialty playbooks, and NPI lookup powered by every dataset on this page.
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If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team