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:
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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