Monday, September 17, 2018

CMS Released CY2017 Claims Data by State

CMS posts annual public Part B data three different ways.

  • CMS posts national Excel files for all CPT codes with utilization and dollars paid (here).   
  • It posts state-level Excel files by MAC subcontract.
    • E.g.. the Noridian subcontract for Utah is one file, the Noridian subcontract for Arizona is another file).  
    • See the state level 2017 data here.  
  • Later - probably around April 2019 - CMS will post physician & lab level claims data for 2017.  
    • That will appear here.   

The state level data appears on the linked webpage as three zip files with a dozen or so Excel spreadsheets each.   Each spreadsheet is named by a Part B MAC contracting zone (usually a state).  You need to read the "Part B Carrier Readme File" pdf on the same webpage to uncode the contractor zones that label the spreadsheets.

I've all put a single zip file of all 50-plus spreadsheets plus the PDF index into the cloud in one zip file here.

State Level MoPath Data

While it's often low utility, tedious, or both, to look at state level data, a few examples.

We know from the national file (link above) that CMS paid $115,586,444 nationally for MoPath unlisted code 81479 in CY2017.   We see from these state files that $44,201,329 was paid in SoCal and $14,533,690 in NCal, totalling $58,735,019 for 81479 or 50.8% of the national spending on 81479.

Utah (03502) has historically led the nation in CMS BRCA payments.  Utah garnered 2017 payments of $30,938,308 for 12,360 uses of BRCA consolidated code (Seq, Dup Del) 81162.   This is relative to nationwide payments of $52,484,618 for 21,018 uses of 81162.    In Utah there were 500 payments for BRCA codes 81211 and 1,244 payments for BRCA code 81213 (respectively $1,044,115 and $728,872).