Pricing
The SSP pricing pipeline produces fee schedules that express the cost of each Standard Service Package in dollar terms and as relative weights.
pos | Meaning | Base rate |
|---|---|---|
IP | Inpatient | $500 |
OP | Outpatient | $500 |
Base rates are used to convert dollar prices into relative weights (price / base_rate). See Methodology for details.
Combo SSPs combine two existing SSPs using multiple procedure logic (100% primary + 50% secondary). They are stored in the same output tables as standard SSPs. See Methodology -- Step 6.
Pipeline Order
The full pricing pipeline runs 14 steps in sequence (via make pricing):
1. ssp_groupings.py # Step 0: SSP groupings with tier multipliers
2. professional_provider_groups.py # Provider group setup
3. manual_institutional_line_codes.py # Step 0b: Claims-derived facility line codes
4. manual_professional_line_codes.py # Step 0b: Claims-derived professional line codes
5. supplemented_sub_package_contents.py # Step 0b: Consolidate sub_package_contents + manual codes
6. revenue_code_family_proportions.py # Step 1: Revenue code family proportions
7. institutional_line_codes.py # Step 2: Institutional line code table
8. ancillary_provider_types.py # Step 2: Ancillary provider type classification
9. institutional_fee_schedule.py # Step 3: Institutional fee schedule
10. professional_line_codes.py # Step 2: Professional line code table
11. professional_ncci_groups.py # Step 2: NCCI group assignment
12. professional_fee_schedule.py # Step 3: Professional fee schedule
13. prices.py # Step 4: Combined tables
14. combo_ssps.py # Step 6: Combo SSPs
For full methodology see Methodology. For column definitions see Data Dictionary. For SQL internals see SQL Reference.
Output Tables
| Table | Granularity |
|---|---|
combined_ssp_fee_schedule | (ssp_grouper, pos, provider_id) |
combined_subcategory_fee_schedule | (ssp_grouper, sub_category, pos, provider_id) |
Output Columns
ID Columns
| Column | Description |
|---|---|
ssp_grouper | Legacy SSP identifier (e.g., CA.0.PCI) |
sub_category | Sub-category within the SSP (0 = base / least severe) |
pos | Place of service: IP or OP |
provider_id | Provider identifier |
ssp_grouper_id | New SSP grouper ID from crosswalk |
sub_category_id | New sub-category ID from crosswalk |
disease_area | Disease area from crosswalk |
parent_description | Parent-level description from crosswalk |
consumer_description | Consumer-facing description from crosswalk |
Price Columns
| Column | Description |
|---|---|
inst_price | Institutional (facility) price, including carve-out add-ons (implants, high-cost drugs) |
primary_price | Primary surgeon / physician fee |
anes_price | Anesthesiologist share (50% of full anesthesia fee) |
crna_price | CRNA share (50% of full anesthesia fee) |
assistant_surgeon_price | Assistant surgeon add-on (16% of primary_price) |
assistant_nonsurgeon_price | Assistant non-surgeon add-on (13.6% of primary_price) |
labpath_price | Lab / pathology add-on |
radiology_price | Radiology add-on |
prof_price | Total professional (sum of all non-facility components) |
Each price column has a corresponding *_medicare_price and *_weight /
*_medicare_weight variant. Weights are computed as price / 500.