• Hi! The search index is currently updating, search results will not include the full scope of the forums until it is complete.

Medicare CPT code per provider

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

DoubleBogey

Full Member
5+ Year Member
Joined
Jul 11, 2017
Messages
244
Reaction score
141
I know there is a way to lookup Physicians/PA/NPs in your state and how many opioids they have prescribed to Medicare patients. Does anyone know how to lookup certain CPT codes billed per provider within a certain state for Medicare patients?
I know it exists, just not sure we have access to it - audits/reviews on certain procedures/codes are conducted using this information (ie the provider billing the most per certain CPT code gets reviewed).
 
I know there is a way to lookup Physicians/PA/NPs in your state and how many opioids they have prescribed to Medicare patients. Does anyone know how to lookup certain CPT codes billed per provider within a certain state for Medicare patients?
I know it exists, just not sure we have access to it - audits/reviews on certain procedures/codes are conducted using this information (ie the provider billing the most per certain CPT code gets reviewed).
The Medicare data is public at Medicare Provider Utilization and Payment Data: Physician and Other Supplier - Centers for Medicare & Medicaid Services though there it is really hard to search. If you go into the database visualizer, you can set a filter by NPI in the upper left, then scrolling right will show you which code was billing how many times.

Looking up a random doctor I know in town, you can see they billed a 99204 47 times that year, a 99214 597 times, a 99213 N times, etc.
 
Top