HCPCS 87426

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

Laboratory

10,092
97th percentile among 6,116 codes billed · 2020
$22M
93rd percentile among 6,116 codes billed · 2020
551K
93rd percentile among 6,116 codes billed · 2020
29
59th percentile among 6,116 codes billed · 2020
159
66th percentile among 6,116 codes billed · 2020

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
Texas1,187$2,871,48563,81829149
New York882$2,339,79565,83946183
Florida726$1,962,43443,89835193
Mississippi479$1,468,92732,85044169
Georgia550$1,122,41131,47631201
New Jersey438$1,107,03224,88137177
Oklahoma245$984,26221,90943241
California350$765,57121,44333194
North Carolina428$757,53821,35423133
Virginia370$670,89818,60823135
Maryland261$653,06014,57632119
Alabama331$618,74717,54834146
Arkansas301$571,59512,6953097
Kentucky322$566,47016,00826157
Tennessee332$492,39313,71523134

Not listed: 3 billers with an armed-forces or unknown state code (AE, ZZ); they are in the national totals.

Not listed: 8 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-NJ1,088$2,929,97777,84746
Dallas-Fort Worth-Arlington, TX277$655,22714,54425
Atlanta-Sandy Springs-Roswell, GA210$456,82612,74531
Los Angeles-Long Beach-Anaheim, CA196$436,66112,32841
Orlando-Kissimmee-Sanford, FL150$435,6509,76940
Baltimore-Columbia-Towson, MD161$353,1997,83738
Washington-Arlington-Alexandria, DC-VA-MD-WV133$330,0867,79421
Houston-Pasadena-The Woodlands, TX137$327,8507,29725
San Antonio-New Braunfels, TX129$323,8237,19437
Oklahoma City, OK90$312,8137,00939
Jackson, MS90$273,9596,13258
Tupelo, MS86$264,2125,90050
Boston-Cambridge-Newton, MA-NH85$260,3267,31820
Tampa-St. Petersburg-Clearwater, FL140$255,1245,66125
Chicago-Naperville-Elgin, IL-IN132$245,7626,86726

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 94 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 87426 nationally

Nurse Practitioner accounts for 31% of payment for 87426 nationally in 2020, across 15 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner3,71937%$6,653,15331%164,94044
Family Practice2,39124%$5,050,36123%128,84154
Physician Assistant1,92819%$3,745,74417%94,41249
Internal Medicine8218.1%$2,339,90311%61,07574
Emergency Medicine7637.6%$2,282,75310%58,93777
Clinical Laboratory470.47%$633,6312.9%15,117322
General Practice940.93%$307,8731.4%7,64581
Pediatric Medicine480.48%$164,2500.75%4,03084
Gastroenterology310.31%$81,6440.37%2,24072
Pulmonary Disease300.30%$44,8010.21%1,11937
General Surgery230.23%$41,3160.19%1,07647
Otolaryngology180.18%$30,9480.14%87549
Hospitalist190.19%$24,3270.11%63133
Cardiology190.19%$23,2730.11%60832
Nephrology120.12%$13,7140.06%36831

Not listed: 41 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 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