Medicare Provider Utilization and Payment Data: Physician and Other Suppliers

Medicare Provider Utilization and Payment Data: Physician and Other Suppliers

Last week when CMS released the public data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUPD for short), most of the articles primarily focused on the top ten physicians with the highest charges.  The focus was on sensationalism and in general missed the main point of this data.

Below are some examples of headlines regarding the release of the data:

"Sliver of Medicare Doctors Get Big Share of Payouts" (New York Times, April 8)

"Doctors' Medicare Pay Revealed" (USA Today, April 8)

"Data Uncover Nation's Top Billers" (Washington Post, April 8)

"Looking Under the Hood of Medicare (USA Today, April 9)

"Medicare Pulls Back the Curtains on How Much it Pays Doctors" (NPR, April 9)

" The Top 10 Medicare Billers Explain Why They Charged $121M in one Year" (Washington Post, April 9)

"Seven Doctors got more than $10M each from Medicare in 2012" (USA Today April 10)

"Find Out How Much Your Doctor Makes from Medicare" (Cleveland Plain Dealer, April 10)

"What Doctors Make from Medicare' (Bloomberg Business Week, April 14)

Although these articles may have mentioned some other points, they primarily focused on the "top billers".  We, at Stratasan, have downloaded the data and analyzed it a little differently.  Below are the top ten Healthcare Common Procedure Coding System (HCPCS) codes in volume in the file.

Physicians who saw one million visits for an office or outpatient visit with an established received on average $54.92 for that visit.  These top ten codes represent 4.3% of the total codes in the database.  The physicians received on average $244 per visit.

PUPD table top HCPCS

We are analyzing the data from a market perspective for customers.  We're analyzing the top physician office visit codes for physicians in their service area giving them insight into what is being seen in their community's physician's offices.

Below are the fields in the data:

  • NPI number
  • Provider Last Name or Organization Last Name
  • Provider First Name
  • Provider Middle Initial
  • Provider Credentials
  • Provider Gender
  • Entity Code (Individual or Organization)
  • Provider Street Address
  • Provider Street Address, second line
  • Provider City
  • Provider ZIP Code
  • Provider State
  • Provider Country
  • Provider Type (Specialty)
  • Medicare Participation Indicator
  • Place of Service (facility or non-facility)
  • HCPCS code
  • HCPCS description
  • Number of services provided
  • Number of distinct Medicare beneficiaries receiving the service
  • Number of distinct Medicare beneficiary/per day services
  • Average Medicare Allowed Amount
  • Standard Deviation of Medicare Allowed Amount
  • Average Submitted Charge Amount
  • Standard Deviation of Submitted Charge Amount
  • Average Medicare Payment Amount
  • Standard Deviation of Medicare Payment Amount

If your organization interested in reports based on this data, contact us at

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