> ## Documentation Index
> Fetch the complete documentation index at: https://docs.pricemedic.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Benchmark Rates Enrichment

> Documentation for the benchmark rates enrichment process that adds Medicare and other benchmark pricing data

## Overview

This enrichment takes the base rate data and adds corresponding Medicare benchmark rates from two primary sources:

* **Medicare RBRVS (Resource-Based Relative Value Scale)** rates by locality
* **Medicare ASP (Average Sales Price)** rates for applicable codes

The process creates locality-specific and national benchmark comparisons to enable comprehensive rate analysis.

## Data Sources

<CardGroup cols={2}>
  <Card title="Medicare RBRVS" icon="calculator">
    **Source**: CMS Medicare Physician Fee Schedule\
    **Coverage**: Professional services with RVU components\
    **Locality**: Geographic adjustment factors applied\
    **Currency**: 2025 fee schedule rates
  </Card>

  <Card title="Medicare ASP" icon="pills">
    **Source**: CMS Average Sales Price files\
    **Coverage**: Drug and biologics pricing\
    **Update**: January 2025 pricing\
    **Scope**: National rates (no locality adjustment)
  </Card>
</CardGroup>

## Output Schema

The enrichment produces 8 additional columns that are joined to the base rate data:

| Field                     | Description                                        | Example                                   |
| ------------------------- | -------------------------------------------------- | ----------------------------------------- |
| `billing_code`            | Procedure or service code for benchmark matching   | "99213", "J0696"                          |
| `benchmark_name`          | Human-readable benchmark source identifier         | "2025 Dallas MCR (CARRIER 0112026)"       |
| `benchmark_type`          | Medicare benchmark methodology used                | "MCR\_RBRVS", "MCR\_ASP"                  |
| `benchmark_rate`          | Locality-adjusted Medicare benchmark rate          | 98.75                                     |
| `national_benchmark_name` | National benchmark source identifier               | "2025 \[National] MCR (CARRIER 00000:00)" |
| `national_benchmark_type` | National benchmark methodology                     | "MCR\_RBRVS", "MCR\_ASP"                  |
| `national_benchmark_rate` | National Medicare rate without locality adjustment | 95.50                                     |

## Processing Logic

This enrichment helps put commercial insurance rates in context by comparing them to what Medicare would pay for the same services.

**Smart Benchmark Selection**\
For doctor visits and medical procedures, the system uses Medicare's physician fee schedule, adjusting the rates based on local practice costs (since medical expenses vary by geographic region). For prescription drugs and biologics, it uses Medicare's drug pricing methodology.

**Apples-to-Apples Comparisons**\
The system carefully matches billing codes between commercial rates and Medicare fee schedules to ensure fair comparisons. It focuses on standard procedures without special modifiers to create the cleanest possible benchmark relationships, using the most current Medicare rates available.