CMS Releases Rich Cloud Database for CY2024 Claims, Medicare Part B

 If you love CMS Part B data, Christmas comes every May or June, when CMS releases extensive cloud data for all labs and all  physician providers of every CPT code.   

CMS classes this as;

Data.cms.gov

>> Provider Summary by Type of Service

>> Medicare Physician and Other Practitioners [incl labs]

Find it here:

https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service

The 2024 data set was released on May 21, 2026.  The same source has year-by-year back files to 2013.  the 2024 data has 9,781,673 rows.   You use it by filtering - for example, every lab that got paid $1 or more for code 81479 (filter on HCPCS = 81479).

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I filtered for codes ending in M or U, plus 811, 812, 813, 814, 815.   This misses the molecular microbiology codes, which are in different ranges up in the 87000-87999 range.  

The codes I did filter - without 877 microbiology - were paid $2,813,342,286, meaning, amost 3 billion dollars.

This produces lines as "lab x code" so, for example, 81479 is split over many lines, many labs.

The top code was 81528, Exact Sciences, $306M, or 11% of all molecular payments.  Next ccame Natera, CareDx, and Caris, all for code 81479, respectively for $104M, $102M, $100M.

The top 10 codes were paid $1.2B or 41% of all molecular payments. About 30% of the top 20 lines were 81479 payments. Click to enlarge.

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I've heard there was a recent boom in uncontrolled (no LCD) payments for 81419, epilepsy panel.  i used Ctl-Alt-L to turn the highlighted "CODES" column into a drop-down-box selection column and checked only 81419.   

Top payments for 81419 epilepsy panel were $73M with with half of national payments going to the top 6 epilepsy panel labs.

Note the states; TX, FL, NJ, PA, TX, FL, FX, FL.  

Nearly all labs getting paid for Epilepsy Gene Panel 81419 in Medicare, were under the Novitas and FCSO MACs, which had in recent years paid around a billion dollars for 81408 (Tier 2 code) and adjacent codes.  That's a code not covered by any other MACs, and one whose payments were apparently finally stopped by OIG.

While payments stopped for 81408 around 2023, by 2024 labs had shifted to a different uncontrolled code [no LCD], 81419, literally just ten digits away in the code book.   

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A New Commercial Source for Rapid Complete Medicare Claims Research LUMA CLAIMS

CMS has some free databases for Part B claims - like this one for annual Excel spreadsheets and this one for a cloud database x CPT code x Provider Name.  And CMS sells anonymous data files of claims data, too.

Now there's a new vender in town.  

I'll copy below an email I got today about LUMA CLAIMS dot COM.   It includes nearly real-time CMS claims processing data (through February 28, about four months ago).  Wow.    Pricing info was not readily available.

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Continuing our partnership with medicareclaimreports.com (now https://lumaclaims.com/), Parrish Law Office is pleased to announce that initial claim approval/denial information for ALL Medicare Part B CPT codes is now available from January 2020 through February 28, 2026. Using a new interactive interface, custom reports examining approval differences by Medicare Administrative Contractor, provider, and State, and time based analyses can be created. Charts, graphs, and raw data of the reports can be downloaded. The data is particularly useful in identifying approval/denial trends and issues, and where Medicare has not issued a local or national coverage determination. 

We use these reports to show that Original Medicare has been covering something when a denial asserts that the item is experimental/investigational.

If this information would be useful in your business, please contact Parrish Law Office for more information or click on this link: www.lumaclaims.com

Debra M. Parrish, Bridget Noonan

Parrish Law Offices     www.dparrishlaw.com

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https://lumaclaims.com/