Data Sources
- Commercial Insurers: UnitedHealthcare, Cigna, Aetna, Humana, Anthem
- Medicare: CMS National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Local Coverage Articles (LCAs)
Coverage Statistics
Medical Coding Systems
- CPT Codes (Current Procedural Terminology): ~10,000 procedure codes
- CPT Modifiers: ~200 procedure modifiers
- HCPCS Level 2 Codes: ~6,500 alphanumeric codes for services and supplies
- HCPCS Modifiers: ~50 service modifiers
- ICD-10-CM Codes (Diagnosis): ~72,000 diagnosis codes with hierarchical structure
- ICD-10-PCS Codes (Procedures): ~78,000 inpatient procedure codes
Insurance Coverage Data
- Insurance Payers: 5 major US insurers (UnitedHealthcare, Cigna, Aetna, Humana, Anthem)
- Lines of Business: Hundreds of lines of business across commercial, Medicare, Medicaid, and exchange markets
- Medical Policies: Thousands of coverage policies including:
- UnitedHealthcare commercial, Medicare Part A/B, Medicare Advantage, Exchange policies
- Cigna commercial policies
- Aetna commercial policies
- Humana commercial and state-specific policies
- Anthem multi-state policies (abc, abcbs, abcny, abcbs_va)
- Medicare NCDs (National Coverage Determinations)
- Medicare LCDs (Local Coverage Determinations) from 20+ contractors
- Medicare Contractors: 20+ Medicare Administrative Contractors (MACs) with state jurisdictions
Update Frequency
- Medicare data: Updated quarterly with CMS releases
- Commercial policies: Monitored continuously, updated as payers publish revisions
- Medical codes: Updated annually (CPT/HCPCS) or as CMS releases updates (ICD-10-CM)