HCPCS 86769

Laboratory test (ClaimLight category; the code descriptor is not shown)

Laboratory

2,011
90th percentile among 6,116 codes billed · 2020
$50M
96th percentile among 6,116 codes billed · 2020
1.2M
96th percentile among 6,116 codes billed · 2020
34
65th percentile among 6,116 codes billed · 2020
822
87th percentile among 6,116 codes billed · 2020

Trend

Medicare payment on the code

$0$20M$40M2020: $50M paid20202021: $50M paid20212022: $28M paid20222023: $9.6M paid20232024: $4.3M paid2024$4.3M$0$20M$40M2020: $50M paid20202021: $50M paid20212022: $28M paid20222023: $9.6M paid20232024: $4.3M paid2024$4.3M$0$20M$40M2020: $50M paid20202021: $50M paid20212022: $28M paid20222023: $9.6M paid20232024: $4.3M paid2024$4.3M$0$20M$40M2020: $50M paid20202021: $50M paid20212022: $28M paid20222023: $9.6M paid20232024: $4.3M paid2024$4.3M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

01,0002,0002020: 2,011 providers20202021: 1,481 providers20212022: 698 providers20222023: 286 providers20232024: 161 providers202416101,0002,0002020: 2,011 providers20202021: 1,481 providers20212022: 698 providers20222023: 286 providers20232024: 161 providers202416101,0002,0002020: 2,011 providers20202021: 1,481 providers20212022: 698 providers20222023: 286 providers20232024: 161 providers202416101,0002,0002020: 2,011 providers20202021: 1,481 providers20212022: 698 providers20222023: 286 providers20232024: 161 providers2024161

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
2024161$4,294,205-55%104,5771243,5550.00
2023286$9,586,898-65%232,5961183,5230.00
2022698$27,712,263-44%665,309653,5820.00
20211,481$49,817,552+0%1,184,606381,5970.00
20202,011$49,643,748first year in data1,182,78934822

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
New Jersey142$13,934,406331,19532771
New York522$6,779,753161,17235396
Florida169$4,600,187109,382381,152
North Carolina67$4,548,931108,13131288
California128$3,421,64582,711872,158
Texas142$2,411,88457,95840641
Arizona42$2,077,06449,37435718
Alabama30$1,239,09729,43147891
Georgia46$1,187,37428,25268960
Massachusetts11$1,177,11227,98212910,719
Illinois155$1,080,05825,68819211
Ohio30$998,59623,722582,370
Pennsylvania24$808,76419,243763,450
Tennessee49$593,17014,17934312
Maryland31$511,89112,18133365

Not listed: 21 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2020.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ507$20,442,753485,85736
Tampa-St. Petersburg-Clearwater, FL11$2,339,62355,579138
Phoenix-Mesa-Chandler, AZ27$2,062,74049,03472
Los Angeles-Long Beach-Anaheim, CA87$2,057,69448,95590
Miami-Fort Lauderdale-West Palm Beach, FL70$1,862,61844,26051
Chicago-Naperville-Elgin, IL-IN152$1,110,71326,41819
Atlanta-Sandy Springs-Roswell, GA17$942,24822,39651
Dallas-Fort Worth-Arlington, TX26$900,86321,40665
Columbus, OH13$691,75316,42415
Houston-Pasadena-The Woodlands, TX23$592,63614,08824
Baltimore-Columbia-Towson, MD18$442,85310,52921
Kansas City, MO-KS27$415,4559,89321
Seattle-Tacoma-Bellevue, WA16$345,3638,20917
Detroit-Warren-Dearborn, MI54$332,3057,98326
Memphis, TN-MS-AR23$243,9585,80433

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 30 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2020.

Specialties billing 86769 nationally

Clinical Laboratory accounts for 90% of payment for 86769 nationally in 2020, across 15 specialties on claims.

observed calculated calculated calculated calculated calculated
Clinical Laboratory39420%$44,502,59590%1,059,8312,690
Internal Medicine64432%$2,044,4874.1%48,84576
Family Practice38719%$985,5082.0%23,63961
Pathology130.65%$597,8941.2%14,3641,105
Nurse Practitioner1527.6%$298,4990.60%7,10547
Rheumatology381.9%$289,7470.58%6,882181
Physician Assistant914.5%$154,4660.31%3,68440
Endocrinology402.0%$145,3990.29%3,47787
Gastroenterology180.90%$138,6040.28%3,294183
Cardiology311.5%$124,8730.25%2,96696
Emergency Medicine522.6%$83,6650.17%2,01439
Hematology-Oncology402.0%$67,6130.14%1,67242
Nephrology130.65%$49,7980.10%1,18291
General Practice120.60%$22,8780.05%55346
Pulmonary Disease120.60%$18,7860.04%44637

Not listed: 23 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2020.

Top billers of 86769 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations