Utilization
Find billing codes, estimate how often a hospital performs them, and browse the CMS and Medicaid utilization tables.
These tools read public volume data: Medicare (procedures and inpatient stays) and Medicaid (dental). Your assistant calls them from your question. Medicare and Medicaid figures are different payers. The tools say which one each row is, and never add them together. Counts are rounded to one decimal and dollars to cents. Everything per hospital is an estimate from state or metro totals, not the hospital's own volume.
search_codes
Turns a description into a code, most-used first. Use it before a price, utilization or Medicare tool.
| Parameter | Type | Default | What it does |
|---|---|---|---|
limit | integer | 20 | Most rows to return. Each tool has its own cap. On a free plan, paid data returns 8 rows whatever you ask for. |
q | string | required | Search the service description, up to 200 characters. |
system | hcpcs | drg | cdt | hcpcs | Which code set to search: hcpcs (CPT and HCPCS), drg or cdt (dental). |
Each row has code, description and the national annual volume: total_services (hcpcs), total_discharges (drg) or total_claim_lines (cdt). Never dollars. Dental (cdt) rows carry the service category in place of a description. One row per code. Every word you search must appear in the description, so fewer words match more; a code with no Medicare or Medicaid volume returns no rows rather than an error. Descriptions are clinical, so "joint replacement" finds DRG 470 where "knee replacement" does not (a few lay words such as colonoscopy, knee and MRI are expanded for you).
estimate_utilization
How many times one hospital (or one dental practice) performs each code in a year.
| Parameter | Type | Default | What it does |
|---|---|---|---|
codes | list of string | required | CPT, HCPCS or MS-DRG codes to look up. |
state | string | required | Two-letter US state, for example FL. A state on its own is not enough: add codes, apc, q or hospital_ids. |
| Field | Meaning |
|---|---|
est_annual_units | State volume divided by the state's hospital count. For dental codes, Medicaid claim lines per dental practice. |
total_units | The state (or national) total behind it. |
hospital_count, provider_count | The divisor: hospitals (Medicare) or dental providers (Medicaid). |
basis_state | The state you asked for, or US when the state figure is suppressed. |
payer | medicare or medicaid. |
avg_medicare_payment, avg_medicare_allowed, avg_medicaid_paid | Average amounts for that payer. |
browse_utilization
One page of a utilization table, with its dollar columns.
| Parameter | Type | Default | What it does |
|---|---|---|---|
category | string | none | Dental category. |
codes | list of string | none | CPT, HCPCS or MS-DRG codes to look up. |
dataset | hcpcs | drg | hcpcs_msa | drg_provider | cdt | dental_category | required | Which CMS or Medicaid utilization table to read. |
dir | asc | desc | none | Sort direction, asc or desc. |
hospital | string | none | A hospital CCN or name, or a metro or hospital id for the dataset you picked. |
limit | integer | 50 | Most rows to return. Each tool has its own cap. On a free plan, paid data returns 8 rows whatever you ask for. |
metro | string | none | Metro area (CBSA) code, 5 digits, for example 12060 for Atlanta. Find it with find_metro. |
offset | integer | 0 | Rows to skip, for paging. |
pos | F | O | none | Place of service. |
q | string | none | Search the service description, up to 200 characters. |
sort | string | none | Column to sort by. |
state | string | none | Two-letter US state, for example FL. A state on its own is not enough: add codes, apc, q or hospital_ids. |
year | string | none | Data year. |
Datasets: hcpcs (Medicare procedures by state, US for national), drg (Medicare inpatient stays by state), hcpcs_msa (procedures by metro), drg_provider (inpatient stays per hospital; hospital takes a CCN or a name fragment), cdt and dental_category (Medicaid dental). limit is at most 200; total is the filtered row count. The free plan gets the first 8 rows (locked: true) with a subscribe link; see Plans & access.
Example questions
- What's the code for a colonoscopy, and how many are done a year in Florida?
- Which procedures does Medicare pay for most in the Atlanta metro?
- How many knee replacements (DRG 470) does a typical Georgia hospital do?
- How many fillings does a dental practice bill Medicaid for in a year?