Medicare Fee-for-Service Utilization & Payments

Provider-, service-, and geography-level Medicare utilization, submitted charges, allowed amounts, and payments across inpatient, outpatient, and professional care.

What Vlada adds: Preserves the publisher data, normalizes schema eras and identifiers, and connects the product to compatible healthcare entities with measured join coverage.

rows: 139.1M; rows
datasets: 8; datasets
cadence: annual; cadence
coverage: 2011-2024; coverage

Publishers: Centers for Medicare & Medicaid Services

What's inside

Medicare Physician & Other Practitioners — by Provider and Service (granular price)

The CMS Medicare Physician & Other Practitioners PUF at the **provider×service** grain: per rendering NPI, HCPCS, and place of service, the average submitted charge, **Medicare allowed**, Medicare paid, and standardized amounts, plus beneficiary/service counts.

grain: One row per (data_year, rendering NPI, HCPCS, place of service) — charge/allowed/paid.

116.3M rows

Medicare PUF (NPI x HCPCS utilization)

Medicare Physician & Other Practitioners PUF — current deduped provider-service cache used by the ghost-rate filter and provider-service lookups.

grain: One row per (NPI, HCPCS, year) — provider service volume.

14.2M rows

Medicare Physician & Other Practitioners by Geography (avg allowed/payment per HCPCS)

CMS public-use file "Medicare Physician & Other Practitioners - by Geography and Service" — annual, claims-derived average Medicare ALLOWED and PAYMENT per professional HCPCS at national + per-state granularity, split by place-of-service (F = facility, O = office/non-facility), with submitted charge, standardized payment, and provider/beneficiary/service counts.

grain: One row per (geography [National|State], HCPCS, place-of-service) per data year.

3.2M rows

Medicare Inpatient Hospitals — by Provider and Service (granular DRG price)

The CMS Medicare Inpatient Hospitals PUF at the provider×DRG grain: per hospital (CCN) and MS-DRG, total discharges, average submitted covered charge, average total payment, and average Medicare payment.

grain: One row per (data_year, hospital CCN, MS-DRG) — discharges + charge + payments.

2.5M rows

Medicare Outpatient Hospitals — by Provider and Service (granular APC price)

The CMS Medicare Outpatient Hospitals PUF at the provider×APC grain: per hospital (CCN) and comprehensive APC, beneficiary/service counts plus average submitted charge, Medicare allowed, Medicare paid, and outlier amounts.

grain: One row per (data_year, hospital CCN, APC) — bene/services + charge + Medicare allowed/paid + outlier.

1.0M rows

Hospital outpatient facility VOLUME (Medicare, by provider & service)

The FACILITY-side outpatient volume signal: per hospital (CCN), per Comprehensive APC, the service count (srvcs) and beneficiary count, plus average submitted charge / Medicare allowed / Medicare payment.

grain: One row per (ccn, Comprehensive-APC, data_year). CMS Medicare Outpatient Hospitals by Provider & Service, 2015-2023. 892,793 rows, 3,773 hospitals.

892.8K rows

Medicare Outpatient Hospitals by Geography (avg payments per APC/HCPCS)

CMS public-use file "Medicare Outpatient Hospitals - by Geography and Service" — annual, claims-derived: beneficiary/service counts + avg submitted charge / Medicare allowed / Medicare payment / outlier per APC (Ambulatory Payment Classification) or HCPCS at national + per-state.

grain: One row per (geography [National|State], APC or HCPCS) per data year.

758.8K rows

Medicare Inpatient Hospitals by Geography (avg payments per MS-DRG)

CMS public-use file "Medicare Inpatient Hospitals - by Geography and Service" — annual, claims-derived: discharges + avg submitted covered charge / total payment / Medicare payment per MS-DRG at national + per-state.

grain: One row per (geography [National|State], MS-DRG) per data year.

331.5K rows