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Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2020 report period (claims submitted July 1, 2018 through June 30, 2019). These claims were used to calculate the FY 2020 Medicare FFS improper payment rate.

The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags medicare cert comprehensive error rate testing fee-for-service improper payment
API Docs
Created
January 21 2021
Views
30

Dataset
This list includes all Medicare enrolled Ambulatory Surgical Centers that converted to Hospitals or Independent Free Standing Emergency Departments enrolled as Hospitals during the COVID-19 public health emergency
Tags No tags assigned
API Docs
Created
January 21 2021
Views
35

Medicare
Dataset
The MCBS COVID-19 Fall 2020 Supplement is a nationally representative, cross-sectional telephone survey of persons who were continuously enrolled in Medicare from the beginning of 2020 and alive and living in the community in Fall 2020, fielded from October 5, 2020 through November 15, 2020. These data are complemented by additional MCBS Community interview data already collected in Fall 2019 on beneficiaries’ health status and demographics as part of the in-person, nationally representative, longitudinal MCBS survey. The MCBS is sponsored by the Centers for Medicare & Medicaid Services (CMS) and directed by the Office of Enterprise Data and Analytics (OEDA).
ANALYTIC NOTE:
The Medicare Current Beneficiary Survey sample is designed to produce national estimates of the Medicare population. The use of the analytic weights in this PUF ensures that the estimates accurately reflect the Medicare population. Failure to use analytic weights provided in the PUF to analyze the data will result in estimates that may misrepresent characteristics of Medicare beneficiaries. For a full explanation of the use of survey weights on the Medicare Current Beneficiary Survey and analytic examples please see our tutorial on weighting and variance estimation located here: https://www.cms.gov/research-statistics-data-and-systemsresearchmcbsdata-briefs/mcbs-advanced-tutorial-weighting-and-variance-estimation. The PUF includes a full-sample weight (CPWFWGT) and a set of 100 replicate weights (CPWF001—CPWF100). The full-sample weight is the primary weight used to ensure that the Medicare population is appropriately represented when producing point estimates. The replicate weights are used for variance estimation under the Balanced Repeated Replication (BRR) method.
Tags mcbs survey covid-19
API Docs
Created
January 14 2021
Views
23

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).
NOTE (1): Data descriptions are available in the Data Dictionary. See the Attachments section on this page to download the Data Dictionary.
NOTE (2): Excel may drop the leading zero from the ACO’s zip code in the aco_zip column when exporting the CSV file. To retain this information, we recommend using the “Import” feature of Excel to manually import the relevant data or exporting the file using one of the other supported file formats.
NOTE (3): The Spanish letter “ñ” may appear as “ñ” or a question mark when downloaded as a CSV file in some software versions. To retain the correct character, we recommend converting the file from CSV to a different format or opening in another software.
DISCLAIMER: This information is current as of January 1, 2021. Changes to ACO information occur periodically. Each ACO has the most up-to-date information about their organization. Consider contacting the ACO for the latest information.
Tags mssp value-based purchasing performance-based payment
API Docs
Created
January 12 2021
Views
136

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).
NOTE (1): Data descriptions are available in the Data Dictionary. See the Attachments section on this page to download the Data Dictionary.
NOTE (2): Excel may drop the leading zero from the ACO’s zip code in the aco_zip column when exporting the CSV file. To retain this information, we recommend using the “Import” feature of Excel to manually import the relevant data or exporting the file using one of the other supported file formats.
NOTE (3): The Spanish letter “ñ” may appear as “ñ” or a question mark when downloaded as a CSV file in some software versions. To retain the correct character, we recommend converting the file from CSV to a different format or opening in another software.
DISCLAIMER: This information is current as of January 1, 2021. Changes to ACO information occur periodically. Each ACO has the most up-to-date information about their organization. Consider contacting the ACO for the latest information.
Tags mssp value-based purchasing performance-based payment
API Docs
Created
January 12 2021
Views
427

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).
NOTE (1): Data descriptions are available in the Data Dictionary. See the Attachments section on this page to download the Data Dictionary.
NOTE (2): Excel may drop the leading zero from the ACO’s zip code in the aco_zip column when exporting the CSV file. To retain this information, we recommend using the “Import” feature of Excel to manually import the relevant data or exporting the file using one of the other supported file formats.
NOTE (3): The Spanish letter “ñ” may appear as “ñ” or a question mark when downloaded as a CSV file in some software versions. To retain the correct character, we recommend converting the file from CSV to a different format or opening in another software.
DISCLAIMER: This information is current as of January 1, 2021. Changes to ACO information occur periodically. Each ACO has the most up-to-date information about their organization. Consider contacting the ACO for the latest information.
Tags mssp value-based purchasing performance-based payment
API Docs
Created
January 11 2021
Views
543

Medicare - Part D
Dataset
The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2018 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
Tags medicare part d opioid prescriber zip code opioidmap and 1 more
API Docs
Created
January 7 2021
Views
178

Special Programs/Initiatives - Long Term Care Facility Staffing Payroll-Based Journal
Dataset
Payroll-Based Journal staffing data submitted by long term care facilities. Data are presented as one row per work day, for each facility.
Tags No tags assigned
API Docs
Created
January 4 2021
Views
115

Special Programs/Initiatives - Long Term Care Facility Staffing Payroll-Based Journal
Dataset
Payroll-Based Journal staffing data submitted by long term care facilities. Data are presented as one row per work day, for each facility.
Tags No tags assigned
API Docs
Created
January 4 2021
Views
274

Dataset
This list includes all Medicare providers that are currently enrolled as Mass Immunizers/Centralized flu billers.
Please download the Mass Immunizers Additional NPIs file for additional NPI information
Please join the Mass Immunizer file to the Additional NPIs file by enrollment id for complete results
Tags No tags assigned
API Docs
Created
December 17 2020
Views
808

Dataset
This dataset powers the search tool at https://data.cms.gov/utilization-and-payment
This should be public and hidden from catalog.
Tags No tags assigned
API Docs
Created
November 19 2020
Views
48

Medicare - Outpatient
Dataset
The Outpatient Hospital Utilization and Payment Public Use File (Outpatient Hospital PUF) presents information on comprehensive APC (C-APC) services provided to Medicare fee-for-service beneficiaries. The Outpatient Hospital PUF presents information on the number of beneficiaries, number of APC services, hospitals' average total estimated submitted charges, the average Medicare allowed charges (which includes Medicare regular provider payments and beneficiary cost-sharing payments), the average Medicare regular provider payments, the number of APC services with outlier payments, and the average Medicare outlier provider payments among those services for 60 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2018 by hospital provider. The estimated average charges and the average Medicare payments are provided at the individual hospital level. The actual charges at an individual hospital for an individual service within these APC groups may differ.
Tags 2018 outpatient mpup
API Docs
Created
November 17 2020
Views
132

Medicare - Part D
Dataset
The Part D Prescriber State Summary Report, Calendar Year 2018 provides information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber State Summary Report is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). For each state and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Tags 2018 mpup summary state part d
API Docs
Created
November 12 2020
Views
116

Medicare - Part D
Dataset
The Part D Prescriber National Summary Report, Calendar Year 2018 provides information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber National Summary Report is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). For each drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Tags mpup 2018 summary national part d
API Docs
Created
November 12 2020
Views
230

Medicare - Part D
Dataset
The Part D Prescriber Summary Table, Calendar Year 2018 provides information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber Summary Table is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and summarizes for each prescriber the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers. Further summaries of total prescriptions and total drug costs are also provided, broken out by beneficiary characteristics and drug categories.
Although the Part D Prescriber PUF and the Prescriber Summary Table have a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
Tags mpup 2018 provider summary payment utilization and 6 more
API Docs
Created
November 12 2020
Views
416

Medicare - Physician/Supplier
Dataset
The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. The data in the Physician and Other Supplier PUF covers calendar year 2018 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Tags aggregate mpup 2018 summary state
API Docs
Created
November 12 2020
Views
358

Medicare - Physician/Supplier
Dataset
The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. The data in the Physician and Other Supplier PUF covers calendar year 2018 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Tags aggregate 2018 mpup national hcpcs
API Docs
Created
November 12 2020
Views
803

Medicare - Physician/Supplier
Dataset
The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Tags 2018 mpup physician aggregate npi
API Docs
Created
November 12 2020
Views
2,567

Medicare - Physician/Supplier
Dataset
CPT copyright 2017 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement/cpt-code/medicare-provider-data
NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers.
The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2018 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Tags mpup npi 2018 hcpcs cpt and 3 more
API Docs
Created
November 12 2020
Views
6,205

Medicare - Part D
Dataset
The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
Tags mpup 2018 provider payment utilization and 6 more
API Docs
Created
November 10 2020
Views
1,396