feat(pfs): valuation rows by vintage from the DuckDB replica with pfs.rules conversion factors (refs P48)
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kert
166
src/pfs/valuation.py
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166
src/pfs/valuation.py
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"""RVUs, conversion factor and national unadjusted payment per code and
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vintage, read from the DuckDB replica (``pfs.rvu`` final years,
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``pfs.rvu_proposed`` for the newest NPRM). Conversion factors come from
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``pfs.rules`` — never from ``pfs.rvu.conv_factor``. Pure DuckDB SQL; no
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narwhals (this module runs inside the ``llm`` container).
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"""
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from __future__ import annotations
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from dataclasses import dataclass
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from typing import Any, Sequence
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from pfs.nprm import NPRM_SOURCES
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from pfs.rules import RULES, proposed_for
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@dataclass(frozen=True)
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class ValuationRow:
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code: str
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description: str
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vintage: str # "CY2026 final" | "CY2027 proposed"
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year: int
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proposed: bool
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status: str
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work: float | None
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pe_nf: float | None
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pe_f: float | None
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mp: float | None
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total_nf: float | None
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total_f: float | None
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cf: float
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pay_nf: float | None
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pay_f: float | None
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label: str # "[PFS CY2026 Addendum B]"
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citation: str # "90 FR 49266"
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url: str
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def vintage_label(year: int, proposed: bool) -> str:
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return f"[CY{year} NPRM Addendum B]" if proposed else f"[PFS CY{year} Addendum B]"
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def fr_citation_url(cite: str) -> str:
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parts = cite.split()
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if len(parts) != 3 or parts[1].upper() != "FR":
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return ""
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return f"https://www.federalregister.gov/citation/{parts[0]}-FR-{parts[2]}"
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def _pay(total: float | None, cf: float) -> float | None:
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return None if total is None else round(total * cf, 2)
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_FINAL_SQL = """
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WITH base AS (
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SELECT hcpcs, year, description, status_code, work_rvu, non_fac_pe_rvu,
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fac_pe_rvu, mp_rvu, non_fac_total, fac_total
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FROM pfs.rvu
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WHERE hcpcs IN (SELECT UNNEST(?::VARCHAR[]))
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QUALIFY row_number() OVER (
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PARTITION BY hcpcs, year ORDER BY (mod IS NULL OR mod = '') DESC, mod
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) = 1
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)
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SELECT * FROM base
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QUALIFY dense_rank() OVER (PARTITION BY hcpcs ORDER BY year DESC) <= ?
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ORDER BY hcpcs, year
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"""
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_PROPOSED_SQL = """
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SELECT hcpcs, description, status_code, work_rvu, non_fac_pe_rvu, fac_pe_rvu, mp_rvu
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FROM pfs.rvu_proposed
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WHERE cms_rule_id = ? AND hcpcs IN (SELECT UNNEST(?::VARCHAR[]))
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QUALIFY row_number() OVER (
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PARTITION BY hcpcs ORDER BY (mod IS NULL OR mod = '') DESC, mod
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) = 1
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ORDER BY hcpcs
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"""
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def _sum(*vals: float | None) -> float | None:
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if any(v is None for v in vals):
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return None
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return round(sum(vals), 4) # type: ignore[arg-type]
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def valuation(
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con: Any, codes: Sequence[str], *, years: int = 4
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) -> tuple[list[ValuationRow], list[str]]:
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"""Rows for *codes* (last *years* final vintages + the newest NPRM),
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ordered by code then year with the proposed row last per code, and the
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codes that produced no rows at all."""
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wanted = sorted({c.upper() for c in codes})
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if not wanted:
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return [], []
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by_code: dict[str, list[ValuationRow]] = {c: [] for c in wanted}
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for hcpcs, year, desc, status, work, pe_nf, pe_f, mp, tot_nf, tot_f in con.execute(
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_FINAL_SQL, [wanted, years]
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).fetchall():
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rule = RULES.get(int(year))
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if rule is None:
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continue
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cf = rule.conversion_factor
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cite = rule.federal_register_citation
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by_code[hcpcs].append(
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ValuationRow(
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code=hcpcs,
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description=desc or "",
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vintage=f"CY{year} final",
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year=int(year),
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proposed=False,
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status=status or "",
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work=work,
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pe_nf=pe_nf,
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pe_f=pe_f,
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mp=mp,
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total_nf=tot_nf,
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total_f=tot_f,
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cf=cf,
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pay_nf=_pay(tot_nf, cf),
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pay_f=_pay(tot_f, cf),
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label=vintage_label(int(year), False),
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citation=cite,
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url=fr_citation_url(cite),
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)
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)
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nprm_year, _tag, rule_id, _pin = max(NPRM_SOURCES, key=lambda s: s[0])
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prop = proposed_for(nprm_year)
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if prop is not None:
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cf = prop.conversion_factor
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cite = prop.federal_register_citation
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for hcpcs, desc, status, work, pe_nf, pe_f, mp in con.execute(
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_PROPOSED_SQL, [rule_id, wanted]
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).fetchall():
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tot_nf, tot_f = _sum(work, pe_nf, mp), _sum(work, pe_f, mp)
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by_code[hcpcs].append(
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ValuationRow(
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code=hcpcs,
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description=desc or "",
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vintage=f"CY{nprm_year} proposed",
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year=nprm_year,
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proposed=True,
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status=status or "",
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work=work,
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pe_nf=pe_nf,
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pe_f=pe_f,
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mp=mp,
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total_nf=tot_nf,
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total_f=tot_f,
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cf=cf,
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pay_nf=_pay(tot_nf, cf),
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pay_f=_pay(tot_f, cf),
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label=vintage_label(nprm_year, True),
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citation=cite,
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url=fr_citation_url(cite),
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)
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)
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rows = [
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r
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for c in wanted
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for r in sorted(by_code[c], key=lambda r: (r.year, r.proposed))
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]
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unpriced = [c for c in wanted if not by_code[c]]
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return rows, unpriced
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215
tests/pfs/test_valuation.py
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215
tests/pfs/test_valuation.py
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"""pfs.valuation — RVUs + national payment by vintage from a DuckDB replica."""
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from __future__ import annotations
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import duckdb
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import pytest
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from pfs.rules import RULES, proposed_for
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from pfs.valuation import ValuationRow, fr_citation_url, valuation, vintage_label
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RVU_COLS = (
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"hcpcs VARCHAR, mod VARCHAR, description VARCHAR, status_code VARCHAR, "
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"work_rvu DOUBLE, non_fac_pe_rvu DOUBLE, fac_pe_rvu DOUBLE, mp_rvu DOUBLE, "
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"non_fac_total DOUBLE, fac_total DOUBLE, conv_factor DOUBLE, year INTEGER"
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)
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PROPOSED_COLS = (
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"hcpcs VARCHAR, mod VARCHAR, description VARCHAR, status_code VARCHAR, "
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"work_rvu DOUBLE, non_fac_pe_rvu DOUBLE, fac_pe_rvu DOUBLE, mp_rvu DOUBLE, cms_rule_id VARCHAR"
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)
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@pytest.fixture
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def con():
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c = duckdb.connect(":memory:")
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c.execute("CREATE SCHEMA pfs")
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c.execute(f"CREATE TABLE pfs.rvu ({RVU_COLS})")
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c.execute(f"CREATE TABLE pfs.rvu_proposed ({PROPOSED_COLS})")
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rows = [
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# G0556: 2025 + 2026 final, with a modifier row that must be ignored
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(
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"G0556",
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None,
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"Adv prim care mgmt lvl 1",
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"A",
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0.25,
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0.20,
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0.10,
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0.02,
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0.47,
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0.37,
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32.3465,
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2025,
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),
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(
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"G0556",
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None,
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"Adv prim care mgmt lvl 1",
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"A",
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0.25,
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0.22,
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0.06,
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0.02,
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0.49,
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0.33,
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33.4009,
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2026,
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),
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(
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"G0556",
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"26",
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"Adv prim care mgmt lvl 1",
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"A",
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9.0,
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9.0,
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9.0,
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9.0,
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27.0,
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27.0,
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33.4009,
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2026,
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),
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# 99490: six years so the last-N cut applies (2021..2026)
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*[
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(
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"99490",
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"",
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"Chrnc care mgmt srvc 20 min",
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"A",
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1.0,
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1.0,
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0.5,
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0.05,
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2.05,
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1.55,
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30.0,
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y,
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)
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for y in range(2021, 2027)
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],
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# I-status code with NULL components
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(
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"G9999",
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None,
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"Not priced",
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"I",
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None,
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None,
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None,
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None,
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None,
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None,
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33.4009,
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2026,
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),
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]
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c.executemany("INSERT INTO pfs.rvu VALUES (?,?,?,?,?,?,?,?,?,?,?,?)", rows)
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c.executemany(
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"INSERT INTO pfs.rvu_proposed VALUES (?,?,?,?,?,?,?,?,?)",
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[
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(
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"G0556",
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None,
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"Adv prim care mgmt lvl 1",
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"A",
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0.25,
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0.23,
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0.07,
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0.02,
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"CMS-1848-P",
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),
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(
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"G0556",
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"26",
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"Adv prim care mgmt lvl 1",
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"A",
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9.0,
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9.0,
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9.0,
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9.0,
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"CMS-1848-P",
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),
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("G0556", None, "older nprm", "A", 0.1, 0.1, 0.1, 0.1, "CMS-1832-P"),
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],
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)
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yield c
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c.close()
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class TestHelpers:
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def test_vintage_label(self):
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assert vintage_label(2026, False) == "[PFS CY2026 Addendum B]"
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assert vintage_label(2027, True) == "[CY2027 NPRM Addendum B]"
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def test_fr_citation_url(self):
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assert (
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fr_citation_url("90 FR 49266")
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== "https://www.federalregister.gov/citation/90-FR-49266"
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)
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assert fr_citation_url("") == ""
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class TestValuation:
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def test_final_and_proposed_rows_with_cf_and_payment(self, con):
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rows, unpriced = valuation(con, ["G0556"], years=4)
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assert unpriced == []
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assert [(r.year, r.proposed) for r in rows] == [
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(2025, False),
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(2026, False),
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(2027, True),
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]
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r26 = rows[1]
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assert isinstance(r26, ValuationRow)
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assert (r26.code, r26.status, r26.work, r26.pe_nf, r26.pe_f, r26.mp) == (
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"G0556",
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"A",
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0.25,
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0.22,
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0.06,
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0.02,
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)
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assert (r26.total_nf, r26.total_f) == (0.49, 0.33)
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assert r26.cf == RULES[2026].conversion_factor
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assert r26.pay_nf == round(0.49 * RULES[2026].conversion_factor, 2)
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assert r26.pay_f == round(0.33 * RULES[2026].conversion_factor, 2)
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assert r26.label == "[PFS CY2026 Addendum B]"
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assert r26.citation == RULES[2026].federal_register_citation
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assert r26.url == fr_citation_url(RULES[2026].federal_register_citation)
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assert r26.vintage == "CY2026 final"
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p = rows[2]
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assert p.label == "[CY2027 NPRM Addendum B]" and p.vintage == "CY2027 proposed"
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assert p.cf == proposed_for(2027).conversion_factor
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assert p.total_nf == round(0.25 + 0.23 + 0.02, 4) and p.total_f == round(
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0.25 + 0.07 + 0.02, 4
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)
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assert p.pay_nf == round(p.total_nf * p.cf, 2)
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assert p.citation == proposed_for(2027).federal_register_citation
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def test_modifier_rows_are_ignored(self, con):
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rows, _ = valuation(con, ["G0556"])
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assert all(r.work == 0.25 for r in rows)
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def test_last_n_years_only(self, con):
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rows, _ = valuation(con, ["99490"], years=4)
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assert [r.year for r in rows if not r.proposed] == [2023, 2024, 2025, 2026]
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def test_unpriced_codes_reported(self, con):
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rows, unpriced = valuation(con, ["G0556", "Z9999"])
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assert unpriced == ["Z9999"]
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assert {r.code for r in rows} == {"G0556"}
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def test_null_components_pass_through(self, con):
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rows, unpriced = valuation(con, ["G9999"])
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assert unpriced == []
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(r,) = rows
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assert r.status == "I" and r.work is None and r.pay_nf is None
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def test_order_is_code_then_year(self, con):
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rows, _ = valuation(con, ["G0556", "99490"], years=2)
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assert [(r.code, r.year) for r in rows] == [
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("99490", 2025),
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("99490", 2026),
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("G0556", 2025),
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("G0556", 2026),
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("G0556", 2027),
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]
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