Medicare Part B Procedure Summary by HCPCS Code and Provider Specialty

Annual summary of calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The data is organized by carrier, pricing locality, HCPCS code, modifier, provider specialty, type of service, and place of service. Summarized fields include total submitted, allowed, denied, and paid service counts and charges.

Use Cases

• Analyze allowed versus denied service patterns by HCPCS code and provider specialty to identify billing anomalies.
• Model total payment amounts by place of service and type of service for Medicare expenditure forecasting.
• Compare total submitted charges and total allowed charges across different pricing localities and carriers.

Strengths

• Data is produced annually by the U.S. Department of Health & Human Services, an authoritative source.
• Claims are summarized by multiple key dimensions including HCPCS code, provider specialty, and place of service.
• Dataset includes detailed financial breakdowns such as total submitted, allowed, denied, and payment amounts.

Limitations

• The dataset is a summary, not individual claim-level records, limiting granular analysis.
• Data is released with a significant lag, typically available in July for the previous calendar year.
• Specific row counts, column counts, and file sizes are not provided in the input.

Provenance

Source

U.S. Department of Health & Human Services

Collection Method

Summary of Medicare Part B carrier and durable medical equipment fee-for-service claims.

Time Range

Calendar year coverage; produced annually.

Freshness

Updated annually; data for a given calendar year is typically available in July of the following year.

Geography

United States (Medicare program).