The CMS Program Statistics - Medicare Part A & Part B - All Types of Service tables provide use and payment data by type of coverage and type of service. For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. Below is the list of tables: MDCR SUMMARY AB 1. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for All Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 2. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Aged Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 3. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Disabled Original Medicare Beneficiaries by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 4. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage, Demographic Characteristics, and Medicare-Medicaid Enrollment Status MDCR SUMMARY AB 5. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage and by Area of Residence MDCR SUMMARY AB 6. Medicare Part A and Part B Summary: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Amount of Program Payments, Type of Coverage, and Type of Service

NCHS has linked data from various surveys with Medicare program enrollment and health care utilization and expenditure data from the Centers for Medicare & Medicaid Services (CMS). Linkage of the NCHS survey participants with the CMS Medicare data provides the opportunity to study changes in health status, health care utilization and costs, and prescription drug use among Medicare enrollees. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

The CMS Program Statistics - Medicare Part D tables provide use and Part D drug costs by type of Part D plan (stand-alone prescription drug plan and Medicare Advantage prescription drug plan). For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. Below is the list of tables: MDCR UTLZN D 1. Medicare Part D Utilization: Average Annual Prescription Drug Fills by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Generic Dispensing Rate, Yearly Trend MDCR UTLZN D 2. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 3. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 4. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan and Demographic Characteristics MDCR UTLZN D 5. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan and Demographic Characteristics MDCR UTLZN D 6. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan, by Area of Residence MDCR UTLZN D 7. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan, by Area of Residence MDCR UTLZN D 8. Medicare Part D Utilization: Number of Part D Utilizers and Average Annual Prescription Drug Fills by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 9. Medicare Part D Utilization: Number of Part D Utilizers and Drug Costs by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 10. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Events (Fills) and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Demographic Characteristics MDCR UTLZN D 11. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Area of Residence

Abstract

Stanford has a 20% sample of CMS data. These data are hosted on our secure servers and can only be accessed after completing a reuse application with CMS. You can explore these data using our CMS Public files which have no restrictions.

Documentation

**A checklist for the steps in gaining access to the CMS RIF 20% sample can be found here: **CMS RIF 20% Sample Access Checklist

**ResDAC has full and current **CMS File Availability and Documentation

The Stanford Center for Population Health Sciences has purchased a 20% sample (linked) of all records from for the files as listed below. Where available, we have purchased all data from 2006 – 2018, though for some files all years are not available. We have the following files and years. N/A indicates that we have not purchased these files.

Medicare Claims Inpatient: N/A Outpatient: 2006-2018 SNF: N/A Hospice: 2006-2018 Home Health: 2006-2018 Carrier: 2006-2018 DMERC: 2006-2018

Part D Event with actual Prescriber/Pharmacy identifiersDrug Characteristics: 2006-2018 Prescriber Characteristics File: N/A Formulary File: 2010-2018 Plan Characteristics Files: 2006-2018

MEDPAR All (SS/LS/SNF): 2006-2018

Enrollment/Summary FilesMaster Beneficiary Summary File: All years. Base Beneficiary Summary File A/B/C/D: 2006-2018 Chronic Conditions: 2006-2018 Cost & Utilization: 2006-2018 Other Chronic or Potentially Disabling Conditions: 2006-2018 National Death Index: N/A EDB User View: Current Vital Status File: Current

MiscellaneousMDPPAS: 2008-2018

The Healthcare Cost Report Information System (HCRIS) contains annual reports submitted by Medicare-certified institutional providers to Medicare Administrative Contractors (MAC). It provides information to CMS that assists with the annual settlement summary between CMS and the institutional provider. The cost report information includes facility level: utilization statistics, costs, charges, medicare payments, and financial information.

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 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

This data package contains the Healthcare Provider Cost Report Information System (HCRIS) contains annual reports submitted by Medicare-certified institutional providers to Medicare Administrative Contractors (MAC).

About this dataset:

-This data is a compilation of the CMS Medicare Part B National Summary Data for CPT/HCPCS Medicine Codes 90281-99xx for 2000-2022. - The information in Part B National Summary Data Files is limited to Medicare Fee-For- Service (FFS) Part B Physician/Supplier data. It does not include information on physician/supplier services for beneficiaries in the managed care portion of the program (Medicare Advantage). -Items/columns include: year, HCPCS/CPT, total annual allowed services, total annual allowed charges, and total annual allowed payment. - These are national annual aggregates. - Note that, per CMS, fields labeled “N/A” mean that the data cannot be disclosed due to Privacy rules. Cell sizes less than 11 have been screened for privacy and replaced with N/A. A zero indicates there were no services or payments rendered for a particular code. - The .csv and .xlsx files hold the same data, just in different formats. - CPT only copyright 2000-2022 American Medical Association. All rights reserved.

Column Descriptions:

Allowed Services: A count of the number of services performed for a procedure.

Allowed Charges: The amount Medicare determines to be reasonable payment for a provider or service covered under Part B. This includes the coinsurance and deductible amounts.

Description: The category corresponding to the HCPCS code, for example: Evaluation and Management, Anesthesia, Dental Services, Pathology/Lab Tests, Chemotherapy Drugs, Medicine, etc

HCPCS (Healthcare Common Procedure Coding System): The HCPCS is a coding system for all services performed by a physician or supplier. It is based on the American Medical Association Physicians Current Procedural Terminology (CPT) codes and is augmented with codes for physician and non-physician services (such as ambulance and durable medical equipment (DME), which are not included in CPTs.

Modifiers: Modifiers denote that a certain procedure/service has been altered by a particular circumstance, but not changed in its definition, therefore the same code is used and a modifier is added to denote what has been altered.

Payment: In the Original Medicare Plan, this is the amount a doctor or supplier that accepts assignment can be paid. It includes what Medicare pays and any deductible, coinsurance, or copayment that the beneficiary must pay. It may be less than the actual amount a doctor or supplier charges.

Additional details can be found in the Medicare Part B National Summary Data Read Me files: file:///C:/Users/sybil/AppData/Local/Temp/3dce003b-ea02-4b37-aaae-c4ef3e6f43a9_PartBNational2010.zip.3a9/PartBNationalSummaryReadmeFile2010.pdf

CMS Data Disclaimer

CMS has no responsibility for the data after it has been converted, processed or otherwise altered. Data that has been manipulated or reprocessed by the user is the responsibility of the user. The user may not present data that has been altered in any way as CMS data. Any alteration of the original data, including conversion to other media or other data formats, is the responsibility of the requestor. Cell sizes less than 11 have been screened for privacy and replaced with N/A. A zero indicates there were no services or payments rendered for a particular code.

ANY USE OF THIS DATA IS AN ACCEPTANCE OF THE FOLLOWING END USER AGREEMENT:

*End User Agreement:

License for Use of Current Procedural Terminology, ANY Edition ("CPT®")

CPT codes, descriptions and other data only are copyright 1995 - 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. Applicable FARS\DFARS Restrictions Apply to Government Use

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial c...

National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.

Medicare certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor. The cost report contains provider information such as facility characteristics, utilization data, cost and charges by cost center, in total and for Medicare, Medicare settlement data, and financial statement data. CMS maintains the cost report data in the Healthcare Provider Cost Reporting Information System, HCRIS. HCRIS includes subsystems for the Hospital Cost Report CMS 2552 96 and CMS 2552 10, Skilled Nursing Facility Cost Report CMS 2540 96, Home Health Agency Cost Report CMS 1728 94, Renal Facility Cost Report CMS 265 94, Health Clinic Cost Report CMS 222 92 and Hospice Cost Report CMS 1984 99.

The data consists of every data element included in the HCRIS extract created for CMS by the providers Administrative Contractor.

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 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Splitgraph serves as an HTTP API that lets you run SQL queries directly on this data to power Web applications. For example:

See the Splitgraph documentation for more information.

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 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

description:

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarizes the utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries by specific inpatient and outpatient hospitals. The dataset includes the following data - common inpatient and outpatient services from 2012 to 2015.

Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure.

Source

GitHub

Hospital Price transparency

The Centers for Medicare and Medicaid Services recently required hospitals under 45 CFR §180.50 to publish a list of prices on their websites. They specifically instruct hospitals to make these lists... - As a comprehensive machine-readable file with all items and services.
- In a display of shoppable services in a consumer-friendly format.

There is a lot of variation in adherence to these policies. Without strong guidance on formatting from CMS, it is no wonder hospitals are all over the map on formatting. Many hospitals have complied with the new rules but in ways that are not consumer friendly. 500 Megabytes of JSON data is not a strong start!

This repository cuts out pricing noise purposefully introduced by these hospital systems. You can easily search for a given CPT or HCPCS code and compare those prices across hospitals.

Supplied Data

If you don't have the proclivity to transform these data yourself with docker, there are CSV extracts available in ./volumes/data/extracts. They are broken down into four distinct groups.

• gross: this is often the top line item that the hospital never actually charges
• cash: this is the self-pay discounted price you would pay without insurance
• max: this is the maximum negotiated rate by an insurance company in the hospital network.
• min: this is the minimum negotiated rate by an insurance company in the hospital network

Ontology

We rely on the excellent work of the Athena vocabulary to define the ontology of healthcare procedures. This maps CPT and HCPCS codes into a common data model.

Coverage

Only North Carolina is covered right now because I happen to live there. Submit a PR if you have found data for other hospital systems.

Usage

Quickstart with docker-compose docker-compose up

Run the flyway migrations docker-compose run flyway

Run the ETL docker-compose run etl

Interactive PSQL client docker exec -it postgres psql -d postgres -U builder

What this is not

I sacrificed some scalabilty for the name of speed. There are some excellent examples how you could scrape your way through this to complete automation. I introduced a s manual step of downloading a file and naming it by the hospital ID. All other transformations are codified and reproducible in the container.

Contact

Submit an issue if you find anything inconsistent. Like all data products, we make assumptions and provide no warrantee.

National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.

The CMS Program Statistics - Medicare Outpatient Facility tables provide use and payment data for all outpatient facilities, including hospitals providing outpatient services, rural health clinics, community mental health centers, federally qualified health centers, outpatient dialysis facilities, comprehensive outpatient rehabilitation facilities, and other outpatient facilities.

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data.

Below is the list of tables:

MDCR OUTPATIENT 1. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 2. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 3. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence MDCR OUTPATIENT 4. Medicare Outpatient Facilities: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Outpatient Facility MDCR OUTPATIENT 5. Medicare Outpatient Facilities: Utilization for Original Medicare Beneficiaries, by Type of Outpatient Facility and Type of Service MDCR OUTPATIENT 6. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 7. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 8. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence MDCR OUTPATIENT 9. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 10. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 11. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence

National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.

This data package contains the data package includes all datasets released by the Centers for Medicare and Medicaid Services (CMS) that belong to the category of Ratebooks & Supporting Data for Medicare Advantage Plan costs estimation. The data contained are related to the two components of the capitated payment (rates and risk scores) and to the county and regional statutory benchmark.

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans).

Notice: CMS has identified an issue that resulted in a 15% coinsurance for plans with Defined Standard benefits to be listed rather than a 25% coinsurance in the Beneficiary Cost File under certain scenarios. This issue affected the 2023 Q4 to 2024 Q3 data. CMS will re-post the corrected data in batches between now and May 2025.

These non-identifiable files are available on a quarterly basis and are comprised of the following tables:

Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

These are large files and can take time to download.

Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information.

Please note: The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the fourth quarter file of 2023. Year 2024 data continues to be available in the Q1-Q3 2024 files, then in the fourth quarter of 2024 year 2025 data becomes available.

Estimated release dates for upcoming 2025 quarterly data (files reflect data for the quarter that ended the month before the file was released):

4/23/25
7/30/25

Files older than contract year 2019 can be purchased.