Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG)

A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related Groups (DRG)

Getting Started

All communication with the API is done through HTTPS, and errors are communicated through HTTP response codes. Available response types include JSON, XML, and CSV, which are selectable by the "extension" on API requests or by HTTP Accepts headers.

This documentation also includes inline, runable examples. Click on any link that contains a gear symbol next to it to run that example live against the Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) API.

App Tokens

All requests should include an app token that identifies your application, and each application should have its own unique app token. A limited number of requests can be made without an app token, but they are subject to much lower throttling limits than request that do include one. If you don't have an app token yet, click the button to the right to sign up for one.

Once you have an app token, you can include it with your request either by using the X-App-Token HTTP header, or by passing it via the $app_token parameter on your URL.

Response Codes

One of the following response codes will be returned with every request:

  1. 200Successful request.
  2. 202Request processing. You can retry your request, and when it's complete, you'll get a 200 instead.
  3. 400Bad request
  4. 401Unauthorized. You're not authorized to access this resource.
  5. 404Not found. The resource requested doesn't exist.
  6. 429Too Many Requests. The client has made too many requests and is currently being rate limited.
  7. 500Server errors. Our bad!

Code Samples

#!/usr/bin/env ruby

require 'net/https'
uri = URI('https://data.cms.gov/resource/inpatient-charge-data-FY2011.json?recall_id=94')

http = Net::HTTP.new(uri.host, uri.port)
http.use_ssl = true
http.verify_mode = OpenSSL::SSL::VERIFY_PEER

request = Net::HTTP::Get.new(uri.request_uri)
request.add_field('X-App-Token', ARGV[0])

response = http.request(request)
puts response.code
puts response.body
#!/usr/bin/env python

import sys
import requests

r = requests.get('https://data.cms.gov/resource/inpatient-charge-data-FY2011.json?recall_id=94', headers={'X-App-Token': sys.argv[1]})
print r.status_code
print r.text
request = require 'request'
options = uri: 'https://data.cms.gov/resource/inpatient-charge-data-FY2011.json?$$app_token=APP_TOKEN&recall_id=94'
request options, (err, response, body) ->  console.log body
#!/bin/sh 

curl --header "X-App-Token: $1" "https://data.cms.gov/resource/inpatient-charge-data-FY2011.json?recall_id=94"

Fields

The following fields are available on the Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) API.

drg_definition

Human Name: DRG Definition
Type: text
Code and description identifying the DRG. DRGs are a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.

Examples

Retrieve all records with drg_definition equal to 948 - SIGNS & SYMPTOMS W/O MCC:
Retrieve all records with drg_definition equal to 948 - SIGNS & SYMPTOMS W/O MCC:

Retrieve all records that occurred after 2012-08-10:

Retrieve all records with drg_definition equal to 948 - SIGNS & SYMPTOMS W/O MCC:

Retrieve all records that are greater than 039 - EXTRACRANIAL PROCEDURES W/O CC/MCC:

Retrieve all records with drg_definition equal to 948 - SIGNS & SYMPTOMS W/O MCC:

Retrieve all records where drg_definition is within 1 kilometer of Seattle, WA (47.598177,-122.33448):

provider_id

Human Name: Provider Id
Type: number
Provider Identifier billing for inpatient hospital services.

provider_name

Human Name: Provider Name
Type: text
Name of the provider.

Examples

Retrieve all records with provider_name equal to ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER:
Retrieve all records with provider_name equal to ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER:

Retrieve all records that occurred after 2012-08-10:

Retrieve all records with provider_name equal to ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER:

Retrieve all records that are greater than ABBEVILLE GENERAL HOSPITAL:

Retrieve all records with provider_name equal to ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER:

Retrieve all records where provider_name is within 1 kilometer of Seattle, WA (47.598177,-122.33448):

provider_street_address

Human Name: Provider Street Address
Type: text
Street address in which the provider is physically located.

Examples

provider_city

Human Name: Provider City
Type: text
City in which the provider is physically located.

provider_state

Human Name: Provider State
Type: text
State in which the provider is physically located.

provider_zip_code

Human Name: Provider Zip Code
Type: number
Zip code in which the provider is physically located.

hospital_referral_region_description

Human Name: Hospital Referral Region Description
Type: text
HRR in which the provider is physically located.

Examples

Retrieve all records with hospital_referral_region_description equal to WY - Casper:
Retrieve all records with hospital_referral_region_description equal to WY - Casper:

Retrieve all records where hospital_referral_region_description is within 1 kilometer of Seattle, WA (47.598177,-122.33448):

total_discharges

Human Name: Total Discharges
Type: number
The number of discharges billed by the provider for inpatient hospital services.

average_covered_charges

Human Name: Average Covered Charges
Type: money
The provider's average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.

average_medicare_payments

Human Name: Average Total Payments
Type: money
The average of Medicare payments to the provider for the DRG including the DRG amount, teaching,  disproportionate share, capital, and outlier payments for all cases. Also included are co-payment and deductible amounts that the patient is responsible for