Wednesday, September 16, 2020

Very Nerdy Note: CMS Releases State Part B Carrier Data File

 Each summer and fall, CMS releases three forms of Part B data.

(1)  Carrier (State) Data File

CMS releases a data file for each MAC subzone, which usually means state.  While tedious, it is possible to merge and reconstruct data by MAC from these 50-plus excel spreadsheets.

  • On September 10, 2020, CMS releases Part B (State) Carrier Files for CY2019.  Here.

It's a little tedious as the 50-spreadsheets are numbered and you need a PDF mapping of the states (e.g. 03502.xls = Utah Pt B).


Not released yet:

(2) National Data File

At some point, CMS will release a national data file of utilization and national total payment for all CPT and HCPCS codes.   It's not released yet for CY2019.  It will appear here as Part B National Summary Data File.


Not Released yet:
(3) Provider/Lab CPT Payments

Since about 2014, CMS releases Part B payments to physicians and labs by CPT code and utilization and payment for each doc and lab.  (E.g. Dr. Smith was paid $1,500 for 25 uses of CPT code 91234).  This is released at an 18 month lag; CY2018 should appear around mid CY2020 but it's not out yet. Here.   This is a good data source because it's a huge cloud database you can sort and cull and then download in Excel.  (For example, you could sort for all CPT codes in the molecular range and all states involved in MOLDX then download that.)