Enter codes separated by commas or spaces. Leave blank to see all codes.
How to read this table
- Quarter: when CMS published the payment determination, which may differ from the service date.
- Lines: reported service lines, including bundled components and default decisions. A line is not necessarily a separate patient, test, or dispute.
- NPIs: distinct reported provider identifiers, excluding missing or malformed values. They are not verified provider-group counts and cannot be added across codes or quarters.
- Win %: provider-winning lines divided by lines with a known provider or insurer winner. Defaults are included unless you select “Exclude defaults.”
- Payouts: reported selected awards in a separate anonymous financial sample, not confirmed collections or additional payments. These amounts cannot be attributed to named providers. Missing amounts and identified component rows are excluded; zero awards are included. Hover over an amount for its sample size.
- Mean, median, and middle 50%: the average, midpoint, and 25th–75th percentile range of available awards. “Middle 50%” sorts by the lower endpoint. Bundled awards can cover multiple services; these are not per-unit prices.
- Scope: laboratory and pathology testing, plus related procedures such as biopsies and specimen collection. Some procedure codes also cover treatment. Unverified entries are available separately. A missing code-quarter pair means no matching reported activity, not a zero-dollar award.
- Clinical context: descriptions and clinician/group types explain typical uses and roles. They do not identify the actual patients, specialties, or organizations in the disputes. Historical or unclear codes may need further review.
Sources
- CMS federal IDR 2025 Q4 public-use file — latest quarter. Every row links to its own quarter’s source file for counts, NPIs, outcomes and descriptions.
- CMS 2025 Q4 Clinical Laboratory Fee Schedule — recognition of unclassified laboratory codes.
- NIH/NLM Medical Tests — general patient explanations; respiratory panels; medicine-level monitoring; toxicology.
- NCI pathology reports — tissue testing context; CMS NCCI policy manual — gross-only versus microscopic pathology.
- CMS 2018 laboratory update — 0025U; CMS melanoma testing article — 81529; CMS laboratory claims manual — HLA and laboratory code descriptions.
- bioMérieux coding information — respiratory PLA codes; CMS laboratory code update — 0315U.