HCPCS 87426

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

Laboratory Work RVU per service none (2024 fee schedule; adds 0 work RVUs)

13,735
98th percentile among 6,471 codes billed · 2024
$18M
91st percentile among 6,471 codes billed · 2024
511K
93rd percentile among 6,471 codes billed · 2024
23
47th percentile among 6,471 codes billed · 2024
101
54th percentile among 6,471 codes billed · 2024
-38.0%
Medicare payment on the code vs 2023; billers -22.6% · 2024

Trend

Medicare payment on the code

$0$25M$50M2020: $22M paid20202021: $67M paid20212022: $62M paid20222023: $28M paid20232024: $18M paid2024$18M$0$25M$50M2020: $22M paid20202021: $67M paid20212022: $62M paid20222023: $28M paid20232024: $18M paid2024$18M$0$25M$50M2020: $22M paid20202021: $67M paid20212022: $62M paid20222023: $28M paid20232024: $18M paid2024$18M$0$25M$50M2020: $22M paid20202021: $67M paid20212022: $62M paid20222023: $28M paid20232024: $18M paid2024$18M

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

Billers

010K20K2020: 10K providers20202021: 25K providers20212022: 25K providers20222023: 18K providers20232024: 14K providers202414K010K20K2020: 10K providers20202021: 25K providers20212022: 25K providers20222023: 18K providers20232024: 14K providers202414K010K20K2020: 10K providers20202021: 25K providers20212022: 25K providers20222023: 18K providers20232024: 14K providers202414K010K20K2020: 10K providers20202021: 25K providers20212022: 25K providers20222023: 18K providers20232024: 14K providers202414K

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
202413,735$17,544,777-38%510,998231010.00
202317,750$28,302,238-54%823,257241190.00
202225,425$62,141,029-7%1,639,527331980.00
202124,677$66,500,277+205%1,694,390362260.00
202010,092$21,787,939first year in data550,90529159

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
Texas1,621$1,777,22651,6032182
Florida1,150$1,723,61750,03127122
New York815$1,450,75042,01625119
California717$1,084,64631,47424117
Virginia800$1,084,49931,60927112
Maryland598$889,45925,96627128
Georgia609$868,17825,38223119
New Jersey621$778,48222,54123101
Mississippi438$772,07022,57336152
Tennessee438$588,48417,25222126
Massachusetts465$531,66615,4282581
Alabama365$529,58715,62528129
Oklahoma333$466,43313,6612895
North Carolina479$430,00312,5341870
Kentucky405$413,42212,1532178

Not listed: 2 billers with an armed-forces or unknown state code (AE); they are in the national totals.

Not listed: 4 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 2024.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ1,077$1,869,10154,11426
Washington-Arlington-Alexandria, DC-VA-MD-WV522$620,80118,12224
Los Angeles-Long Beach-Anaheim, CA329$569,17916,46724
Baltimore-Columbia-Towson, MD320$501,38614,64430
Dallas-Fort Worth-Arlington, TX467$491,87114,26720
Boston-Cambridge-Newton, MA-NH375$405,05511,74325
Houston-Pasadena-The Woodlands, TX375$395,03011,43621
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD270$362,95010,51021
Atlanta-Sandy Springs-Roswell, GA269$359,74910,51821
Miami-Fort Lauderdale-West Palm Beach, FL230$314,3569,09623
Detroit-Warren-Dearborn, MI237$312,8289,09222
Orlando-Kissimmee-Sanford, FL167$293,4078,53640
Virginia Beach-Chesapeake-Norfolk, VA-NC179$260,3257,61730
Richmond, VA153$219,7626,38733
Jackson, MS94$212,8366,21752

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 97 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2024.

Specialties billing 87426 nationally

Nurse Practitioner accounts for 34% of payment for 87426 nationally in 2024, across 12 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner5,57741%$5,926,32434%172,81031
Family Practice2,96822%$4,180,89324%122,03241
Physician Assistant2,73820%$3,127,02618%90,94433
Internal Medicine1,3389.7%$2,005,38011%58,31644
Emergency Medicine6885.0%$1,079,5026.2%31,36246
Clinical Laboratory1220.89%$517,2702.9%14,960123
Pediatric Medicine300.22%$173,6910.99%5,024167
General Practice810.59%$114,5710.65%3,33341
Pulmonary Disease200.15%$47,0740.27%1,37369
Allergy/ Immunology110.08%$40,9580.23%1,190108
Hospitalist220.16%$37,0840.21%1,07849
General Surgery220.16%$32,3780.18%94243

Not listed: 34 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 2024.

Top billers of 87426 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