Medicare Clinical Laboratory Private Payer Rates and Volumes

The dataset contains raw data reported by applicable laboratories for the Medicare Clinical Laboratory Fee Schedule. It includes private payor rates and associated test volumes for laboratory tests, as mandated by the Protecting Access to Medicare Act. Laboratories must report if their volume exceeds 10 tests for the collection period.

Use Cases

• Analyze private payor rate distributions for specific laboratory tests to understand market pricing.
• Correlate reported test volumes with payor rates to identify volume-based pricing trends.
• Assess compliance by filtering for laboratories reporting volumes greater than the 10-test threshold.

Strengths

• Data is sourced from the U.S. Department of Health & Human Services, an authoritative government agency.
• Reporting is mandated by federal law (Protecting Access to Medicare Act), ensuring a defined collection scope.
• The dataset was last updated in December 2025, indicating recent maintenance.

Limitations

• The specific number of rows, columns, and data volume is unknown, hindering assessment of analytical scale.
• Data completeness relies on self-reporting by applicable laboratories, which may introduce gaps or inconsistencies.

Provenance

Source

U.S. Department of Health & Human Services

Collection Method

Mandatory reporting by applicable laboratories to CMS under the Protecting Access to Medicare Act.

Freshness

Last updated on 2025-12-11.

Geography

United States