The Physician/Supplier Procedure Summary (PSPS) data provides a summary of calendar year Medicare Part B carrier and durable medical equipment fee-for-service (FFS) claims. The file is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service. The summarized fields are total submitted services and charges, total allowed services and charges, total denied services and charges, and total payment amounts.  This dataset is produced annually and is typically available in July (i.e., data for CY2015 is usually available in July 2016).

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Medicare Physician & Other Practitioners by Provider dataset provides information on use, payments, submitted charges and beneficiary demographic and health characteristics organized by National Provider Identifier (NPI).

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Publicly Reported Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Measures data provides information on hospital-level measures rates for four of the HACs included in the DRA HAC payment provision – foreign object retained after surgery, blood incompatibility, air embolism, and falls and trauma – for Medicare fee-for-service discharges. The Publicly Reported DRA HAC Measures are reported only for informational and quality improvement purposes; the results of the measure calculations do not affect payment and are not a part of the HAC Reduction Program.

The Quality Payment Program (QPP) Experience dataset provides participation and performance information in the Merit-based Incentive Payment System (MIPS) during each performance year. They cover eligibility and participation, performance categories, and final score and payment adjustments. The dataset provides additional details at the TIN/NPI level on what was published in the previous performance year. You can sort the data by variables like clinician type, practice size, scores, and payment adjustments.

The Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) dataset provides information on a random sample of FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules. The dataset contains information on type of FFS claim, Diagnosis Related Group (DRG) and Healthcare Common Procedure Coding System (HCPCS) codes, provider type, type of bill, review decision, and error code.

 

Please note, each reporting year (RY) contains claims submitted July 1 two years before the report through June 30 one year before the report. For example, the 2023 data contains claims submitted July 1, 2021 through June 30, 2022.

The Medicare Physician & Other Practitioners by Provider and Service dataset provides information on use, payments, and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service.

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans). These non-identifiable files are available on a quarterly basis and are comprised of the following tables:

 

Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
Partial Gap Coverage - Plan-RxCUI combinations that are on tiers that offer gap coverage for some drugs on the tier.
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

 

These are large files and can take time to download. 

 

Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

 

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information.

 

Please note:  The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the fourth quarter file of 2023. Year 2024 data continues to be available in the Q1-Q3 2024  files, then in the fourth quarter of 2024 year 2025 data becomes available. 

Estimated release dates for upcoming 2024 quarterly data (files reflect data for the quarter that ended the month before the file was released):

10/16/24
1/29/25
4/23/25
7/30/25

Files older than contract year 2019 can be purchased.

The Hospital Provider Cost Report dataset provides select measures from the hospital annual cost report. This data includes provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data organized by CMS Certification Number.

The Payroll Based Journal (PBJ) Nurse Staffing and Non-Nurse Staffing datasets provide information submitted by nursing homes including rehabilitation services on a quarterly basis. The View Data link above includes the hours staff are paid to work each day, for each facility, aggregated by staff reporting category.  Examples of reporting categories include Director of Nursing, Administrative Registered Nurses, Registered Nursing, Administrative Licensed Practice Nurses, Licensed Practice Nurses, Certified Nurse Aides, Certified Medication Aides, and Nurse Aides in Training. There are also other non-nurse staff categories provided in the data such as Respiratory Therapist, Occupational Therapist, and Social Worker. The datasets also include a facility’s daily census calculated using the Minimum Data Set (MDS) submission.

The Payroll Based Journal (PBJ) Employee Detail Nursing Home Staffing datasets and technical information have been moved to a new location.

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Medicare Inpatient Hospitals by Provider and Service dataset provides information on inpatient discharges for Original Medicare Part A beneficiaries by IPPS hospitals. It includes information on the use, payment, and hospital charges for more than 3,000 U.S. hospitals that received IPPS payments. The data are organized by hospital and Medicare Severity Diagnosis Related Group (DRG).

 

Hospitals determine what they will charge for items and services provided to patients, and these charges are the amount the hospital bills for an item or service. The Total Payment Amount includes the DRG amount, claim per diem amount, beneficiary primary payer claim payment amount, beneficiary Part A (Hospital Insurance) coinsurance amount, beneficiary deductible amount, beneficiary blood deductible amount and diagnosis related group outlier amount.