HCPCS 87426

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

Laboratory Work RVU per service none (2021 fee schedule; adds 0 work RVUs)

24,677
99th percentile among 6,253 codes billed · 2021
$67M
97th percentile among 6,253 codes billed · 2021
1.7M
97th percentile among 6,253 codes billed · 2021
36
66th percentile among 6,253 codes billed · 2021
226
71st percentile among 6,253 codes billed · 2021
+205.2%
Medicare payment on the code vs 2020; billers +144.5% · 2021

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
New York1,661$8,062,623225,53471439
Texas2,411$6,719,445149,62533193
Florida1,580$6,113,776136,69344287
New Jersey1,007$4,454,730100,16353326
Maryland851$3,552,26079,19243293
Georgia1,204$2,818,06079,38038192
Virginia1,140$2,501,69768,05932206
California834$2,340,39065,89035283
North Carolina1,217$2,325,56365,38133151
Mississippi676$2,203,88749,32846212
Pennsylvania761$2,120,59447,67541160
Oklahoma559$1,614,86836,09038195
Illinois601$1,595,71744,82333233
Ohio857$1,526,44842,81832140
Kentucky827$1,479,19741,89030162

Not listed: 4 billers with an armed-forces or unknown state code (AE, ZZ); they are in the national totals.

Not listed: 3 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 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ2,108$10,672,727279,84771
Washington-Arlington-Alexandria, DC-VA-MD-WV662$2,007,68547,43630
Baltimore-Columbia-Towson, MD473$1,865,35841,39850
Dallas-Fort Worth-Arlington, TX664$1,594,35135,53328
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD366$1,438,32432,14154
Atlanta-Sandy Springs-Roswell, GA566$1,338,17037,70339
Chicago-Naperville-Elgin, IL-IN412$1,211,35234,12439
Miami-Fort Lauderdale-West Palm Beach, FL263$1,209,40327,15640
Houston-Pasadena-The Woodlands, TX387$1,200,80726,74734
Los Angeles-Long Beach-Anaheim, CA402$1,151,70132,47238
Orlando-Kissimmee-Sanford, FL261$1,036,16423,08055
Detroit-Warren-Dearborn, MI304$972,83727,56445
San Antonio-New Braunfels, TX229$871,91219,41949
Tampa-St. Petersburg-Clearwater, FL310$833,27118,61834
Boston-Cambridge-Newton, MA-NH290$640,03218,07436

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 100 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.

Specialties billing 87426 nationally

Nurse Practitioner accounts for 37% of payment for 87426 nationally in 2021, across 27 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner10,61143%$24,888,69537%631,36060
Family Practice5,06921%$12,869,68319%329,17065
Physician Assistant4,58119%$11,459,10417%291,29264
Emergency Medicine1,1544.7%$6,541,1969.8%167,398145
Internal Medicine1,9177.8%$5,531,6298.3%142,62974
Clinical Laboratory2861.2%$1,684,0512.5%42,664149
General Practice1720.70%$715,8411.1%17,839104
Gastroenterology1270.51%$408,7290.61%10,43982
Pediatric Medicine820.33%$396,2400.60%9,619117
Pulmonary Disease1030.42%$251,2120.38%6,25561
General Surgery320.13%$152,4670.23%3,766118
Cardiology760.31%$143,4830.22%3,78050
Pathology140.06%$136,9850.21%3,798271
Hospitalist310.13%$102,0870.15%2,50981
Otolaryngology490.20%$96,5220.15%2,63654

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 2021.

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