The Department of Health and Human Services (HHS) released a new dataset containing physician-level Medicare data from 2012, including the types and numbers of services provided, amounts paid to providers, and other information. The dataset includes over 880,000 health care providers who collectively received $77 billion from Medicare. It identifies individual providers and the services they provide, along with payments and utilization statistics. The data will allow analyses comparing services, payments, and practice patterns among providers and specialties. The top specialties by Medicare payments were internal medicine, family practice, cardiology, and orthopedic surgery.

1. HHS Physician-Level
Medicare Data Released
Richard Bays JD, MBA, RN
April 2014

2. HHS Releases Physician-Level Medicare Data
• The Department of Health and Human Services (HHS) released
a new privacy-protected data set that has information on the
number and type of health care services that individual
physicians and certain other health care providers furnished in
2012 under the Medicare Part B fee-for-service (FFS) program,
as well as information on the amount that Medicare paid them
for those services.
• The new data set has information for over 880,000 distinct
health care providers in all 50 states, DC and Puerto Rico who
collectively received $77 billion in Medicare payments in 2012.
The new data are posted on the website of the Centers for
Medicare & Medicaid Services (CMS).

3. HHS Releases Physician-Level Medicare Data
• CMS created the new data set using information from the
Physician/Supplier Part B Claims File, also known as the Carrier
File, which has final action FFS claims that are submitted by
physicians and other non-institutional health care providers, such as
non-physician practitioners, ambulatory surgical centers, clinical
laboratories, and ambulance providers.
• The new data set does not have information for institutional health
care providers, such as hospitals or nursing homes, or for suppliers
of durable medical equipment; some data on these types of
providers is already publicly available:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-
Trends-and-Reports/Medicare-Provider-Charge-Data/

4. HHS Releases Physician-Level Medicare Data
• The new data set identifies individual providers using their National
Provider Identifier (NPI) and the specific services that they furnished
using Healthcare Common Procedure Coding System (HCPCS) codes.
• For each provider and service, the new data set has the total number of
services that were furnished, the provider’s average charge, the
average Medicare payment, and the average Medicare-allowed
amount, which is the sum of Medicare’s payment and any deductible or
coinsurance owed by the beneficiary.
• The new data set also has the standard deviation for each payment
metric, so that users of the data can better understand how much the
payment amounts varied, even for a specific service. CMS did not
include information in cases where a provider furnished 10 or fewer
units of a particular service to ensure the confidentiality of patient-
specific information.

5. HHS Releases Physician-Level Medicare Data
• When health care providers obtain an NPI, they indicate
whether the NPI will be used by an individual or an organization
and the specialty that best describes the type of health care
services that they furnish.
• The chart on the next slide shows the ten specialties with the
highest aggregate Medicare payments in the new data set;
together, those provider specialties accounted for 57 percent
($44 billion) of the total Medicare payments included in the new
data set.

6. Provider Specialties with the Highest Medicare Payments

7. Provider Specialties with the Highest Medicare Payments
• The new data set will make it possible to conduct a wide range of analyses that
compare the services provided and payments received by individual health
care providers.
• For example, the next table shows the ten physician specialties that had the
highest Medicare-allowed amount per individual physician, on average. (It does
not include figures for any specialty that had fewer than 500 providers.)
• It is worth noting that the top four specialties – hematology/oncology, radiation
oncology, ophthalmology, and medical oncology – often use Part B-covered
prescription drugs, which are usually administered by a physician. In those
cases, Medicare’s payment to the physician also includes payments for the
drugs themselves.

8. Specialties with the Highest Medicare-
Allowed Amount per Individual Physician

9. Office Visit Codes by Specialty
• The new data set can also be used to examine how patterns of
service use vary across physicians and specialties. For example,
Medicare has five different HCPCS codes (99211-99215) for routine
office visits, based on the length of the visit. The Medicare-allowed
amount for those codes in 2012 ranged from $20 for 99211, a 5-
minute visit, to $140 for 99215, a 40-minute visit.
• The next chart shows how often the physicians in four specialties
used those codes; the red dots represent the national averages.
Neurologists were more likely to use one of the higher-valued codes
(99214 or 99215), while dermatologists are more likely to bill 99212
or 99213.

10. Office Visit Codes by Specialty

11. Variation Among Physicians
• The new data set can also be used to examine the variation
across individual physicians in how often they provided a
particular service. For example, there were 55,000 internal
medicine physicians who provided one of the longer office visits
(the 99214 code) at least 11 times in 2012. The average internal
medicine physician provided this service 377 times over the
course of the year, but there was wide variation around this
average. About 26 percent of internal medicine physicians
furnished this service less than 100 times, while another 16
percent provided this service at least 700 times.

12. Delivery of Longer Office Visits (HCPCS
Code 99214) by Internal Medicine Physicians

13. Top Code by Specialty
• The new data set also suggests the most physicians provide a
relatively limited number of distinct health care services. For
example, cardiologists as a group submitted claims for 1,346
different HCPCS codes, but individual cardiologists only
submitted claims for 23 codes, on average.
• A single HCPCS code often accounted for a substantial share of
the Medicare payments for a particular specialty. The next chart
shows ten different specialties, the individual code that
accounted for the most Medicare payments for that specialty,
and the payments for that top code as a percentage of the
overall total.

14. Top Code by Specialty

15. Medicare Payment, Total Services, and Number of
Providers for Selected HCPCS Codes
• The following graph examines the relationship between total
Medicare payment, total services, and number of providers for
selected procedures and healthcare services within a provider
specialty.
• The 99214 code, which appears for internal medicine, family
practice, and cardiology, has a large payment amount driven by
a large number of services. Other codes, such as A0427 (ALS1-
emergency), have high total payments due to a high per-service
payment amount.

16. Medicare Payment, Total Services, and Number of
Providers for Selected HCPCS Codes

17. For More Information:
• For additional information on how Medicare pays for physician
services, please see: http://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/MedicareClaimSubmissionGuide
lines-ICN906764.pdf

18. Contact Information
Richard Bays JD, MBA, RN, CPHQ
RBaysConsulting@Gmail.com
Houston Office +1 832.316.2701