HCPCS 87426

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

Laboratory Work RVU per service none (2022 fee schedule; adds 0 work RVUs)

25,425
99th percentile among 6,326 codes billed · 2022
$62M
97th percentile among 6,326 codes billed · 2022
1.6M
97th percentile among 6,326 codes billed · 2022
33
63rd percentile among 6,326 codes billed · 2022
198
69th percentile among 6,326 codes billed · 2022
-6.6%
Medicare payment on the code vs 2021; billers +3.0% · 2022

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 York1,718$7,250,238206,50765399
Texas2,613$6,533,745154,84430163
Florida1,664$6,178,673146,72441295
New Jersey996$4,403,886106,35150298
California1,060$3,383,44896,81033315
Georgia1,142$2,544,43372,65733200
Mississippi791$2,425,36857,67947210
Maryland801$2,176,92152,06831218
Virginia1,088$2,138,36859,62030173
North Carolina1,251$2,108,38159,95529144
Tennessee1,016$1,904,88554,43236140
Oklahoma617$1,626,00638,88043174
Illinois585$1,563,08544,59229204
Pennsylvania644$1,436,52634,56936137
Kentucky914$1,339,60738,77927113

Not listed: 8 billers with an armed-forces or unknown state code (AA, AE, AP, ZZ); they are in the national totals.

Not listed: 2 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 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ2,146$10,293,633277,59672
Los Angeles-Long Beach-Anaheim, CA545$1,926,88155,17233
Dallas-Fort Worth-Arlington, TX806$1,900,12945,26126
Washington-Arlington-Alexandria, DC-VA-MD-WV667$1,637,47741,22627
Miami-Fort Lauderdale-West Palm Beach, FL330$1,444,82434,33150
Chicago-Naperville-Elgin, IL-IN412$1,315,33837,60033
Atlanta-Sandy Springs-Roswell, GA489$1,119,93231,84031
Houston-Pasadena-The Woodlands, TX394$1,093,26925,78835
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD332$947,98822,78034
San Antonio-New Braunfels, TX238$877,12620,82336
Baltimore-Columbia-Towson, MD425$866,00920,60929
Orlando-Kissimmee-Sanford, FL255$836,73519,72243
Tampa-St. Petersburg-Clearwater, FL260$741,81317,59339
Detroit-Warren-Dearborn, MI267$695,65719,94330
Jacksonville, FL100$584,62813,95740

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 98 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2022.

Specialties billing 87426 nationally

Nurse Practitioner accounts for 35% of payment for 87426 nationally in 2022, across 24 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner10,98043%$21,738,70935%569,08952
Family Practice5,33921%$12,523,21920%332,13362
Physician Assistant4,59418%$9,910,14416%263,36657
Internal Medicine2,2068.7%$5,538,6978.9%147,40667
Emergency Medicine1,0444.1%$5,462,9808.8%144,967139
Clinical Laboratory3831.5%$3,678,1525.9%95,200249
General Practice1740.68%$790,0711.3%20,903120
Gastroenterology610.24%$304,4440.49%7,950130
Pediatric Medicine700.28%$228,3640.37%5,67881
General Surgery240.09%$158,3940.25%4,009167
Pulmonary Disease780.31%$146,0810.24%3,87050
Hospitalist340.13%$132,3880.21%3,36999
Urology230.09%$127,8590.21%3,680160
Cardiology390.15%$112,8390.18%3,10680
Otolaryngology360.14%$81,8680.13%2,20461

Not listed: 38 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 2022.

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