Thursday, December 15, 2016

Brief Blog: CMS Publishes CY2015 CPT Code Utilization in Part B

Each year, about November or December, CMS publishes Excel spreadshees of CPT code utilization in Part B nationally for the prior year.

  • CMS has just released CY2015 data on its National Part B Utilization website, here

The file structure is a little unusual.  Download the "CY2015" data link on this webpage.  This will give you a folder with a 2015 Readme PDF and another folder, CY2015 data.  Inside the folder for CY2015 data, you will now see a 2014 Readme PDF and another folder CY2014 data.  However, inside THAT folder, are about two dozen HCPCS and CPT code utilization files, labeled Y2015...XLS.   Therefore, I believe these must be Y2015 files.

Although the total data is only about 2 MB, CMS breaks it into very small CPT code series, so about 20 excel files are there.

Will Gigabyte Physician Level Data Appear Again?

For the last several years, each April or May, CMS has released vastly larger data sets, including data broken down by physician, laboratory, and other Part B billing entities.  (E.g. - you can look up that your Dr. Smith on Oak Street billed Medicare for 845, 30 minute office visits.  That data homepage is here.)   CMS began releases this gigabyte-sized data after a court ruling that it could be obtained by third-party entities through FOIA.

AMA has not liked this release of physician data.  If the new administration is more AMA-friendly, it might discontinue the physician-level data dumps.

Category III Codes

These data tables list about 140 Category III codes.  8 were used 230,000 times for $166M   The rest - the other 135 codes - were used for a total of $2.5M, and only a couple dozen used more than 100 times.  The vast majority of all Category III dollars in 2015 went to 0191T, anterior segment drainage device, 52,000 uses, $64M, and electronic brachytherapy 0182T (later split into several newer codes), for 50,000 uses at $87M.