Total Spend
Billing Providers
Claim Lines
Providers
Total Paid
Claim Lines
Median Paid / Line
Codes
Groups
Total Paid
Claim Lines
Median Paid / Line
Rows
Total Paid
Claim Lines
Providers
This application summarizes Wisconsin Medicaid provider spending using the HHS Medicaid Provider Spending dataset.
The data are aggregated from outpatient and professional Medicaid claim lines with populated HCPCS procedure codes.
Spending totals in this app represent provider-attributed outpatient and professional Medicaid payments.
They should not be interpreted as total Wisconsin Medicaid expenditures. Roughly speaking, the annual Medicaid expenditure in Wisconsin has been around $12-13B (while the most recent budget is closer to $18B). This dataset only accounts for ~$10B in spending over a 7-year period, which amounts to roughly 10% of total Medicaid expenditure over that time period.
- ✅ Outpatient and professional claim-line payments
- ✅ HCPCS/CPT-coded services
- ✅ Office visits, ED visits, imaging, labs, procedures, drugs, supplies, and transportation
- ✅ Rows with identifiable billing and servicing provider NPIs
- ✅ Provider-level summaries by month, procedure code, claim lines, beneficiaries, and payment amount
Individual code labels were obtained from the Medicare Physician Fee Schedule files, and the code categorizations from the BETOS Classification System
- ⚠️ Inpatient hospital facility claims, such as DRG-based admissions
- ⚠️ Most long-term care and institutional care spending
- ⚠️ Managed care capitation payments
- ⚠️ Supplemental payments and other program-level financial flows
- ⚠️ Claim lines without complete billing and servicing provider attribution
Billing provider: the provider or organization responsible for submitting the claim and receiving payment.
Servicing provider: the individual or organization associated with delivering the service.
Provider information is linked using National Provider Identifier (NPI) records.
Provider location is based on NPI registry information and may not perfectly represent where care was delivered.
- Beneficiary counts are unique within each provider-code-month cell and should not be summed as unique people across rows.
- Claim-line counts represent service lines, not top-level claims or patient encounters.
- Payment totals are best used for relative comparisons and trend analysis within this outpatient/professional slice of Medicaid.
This app is best used to explore provider-level and service-level patterns: who is billing, what services are being paid for, how spending changes over time, and which procedures account for the largest payment totals.