Healthcare
34 columns
105 rows
8 formats

Medical Claims Transactions - Professional (CMS-1500)

This dataset provides granular details on professional medical claims transactions, including patient demographics, provider information, CPT codes, diagnosis codes and pointers, financial charges, allowed and paid amounts, and payment status. It is ideal for healthcare analytics, reimbursement modeling, fraud detection, and operational reporting in clinical and insurance environments.

opened 5 times
last updated 2 Nov 2025
by GoMask

The brief that made it

Claims adjudication and payment analysis

Sample rows

preview · 8 of 105 rows · all 34 columns

claim_idstring	cpt_modifier_1string	paid_amountfloat	diagnosis_code_2string	patient_idstring	provider_idstring	service_datedate	claim_submission_datedate	cpt_codestring	cpt_modifier_2string	diagnosis_code_1string	diagnosis_code_3string	diagnosis_pointer_1integer	diagnosis_pointer_2integer	charge_amountfloat	allowed_amountfloat	payment_datedate	payer_idstring	claim_statusstring	place_of_service_codestring	referring_provider_idstring	rendering_provider_idstring	patient_first_namestring	patient_last_namestring	patient_date_of_birthdate	patient_genderstring	patient_address_streetstring	patient_address_citystring	patient_address_statestring	patient_address_postal_codestring	patient_address_countrystring	insurance_policy_numberstring	insurance_group_numberstring	claim_notesstring
CLM000001	25	85	blank	PAT0001	PRV0001	2023-03-15	2023-03-17	99213	blank	E11.9	blank	1	blank	120	85	2023-04-04	PYR0001	paid	11	blank	blank	Ashley	Smith	1988-06-22	female	456 Market St	San Francisco	CA	94105	USA	A3C2B9D8F7	G1234	Routine follow-up visit for diabetes management. No complications reported.
CLM000002	blank	180	blank	PAT0002	PRV0002	2023-04-10	2023-04-12	80050	blank	Z00.00	blank	1	blank	240	180	2023-04-25	PYR0002	paid	22	PRV0003	blank	Michael	Taylor	1991-02-10	male	789 Lakeview Ave	Dallas	TX	75201	USA	B7D5E3A1C9	G2345	Comprehensive metabolic panel for annual physical exam.
CLM000003	TC	540	R53.83	PAT0003	PRV0001	2023-05-02	2023-05-03	70450	blank	M54.5	blank	1	2	720	540	2023-05-21	PYR0003	paid	22	blank	PRV0004	Linda	Johnson	1972-09-04	female	322 Main St	Chicago	IL	60601	USA	C8F9G6B2D5	G3456	CT scan of lumbar spine for evaluation of chronic back pain.
CLM000004	blank	100	blank	PAT0004	PRV0005	2023-01-18	2023-01-18	99385	blank	I10	blank	1	blank	160	100	2023-02-02	PYR0004	paid	11	blank	blank	James	Lee	1956-11-12	male	45 Oak St	Miami	FL	33101	USA	D2E4A7B8C1	blank	Annual preventive exam for hypertension monitoring.
CLM000005	blank	62	blank	PAT0005	PRV0006	2023-02-27	2023-03-01	96372	blank	Z23	blank	1	blank	83	62	2023-03-19	PYR0005	paid	11	PRV0007	blank	Emily	Garcia	2017-12-09	female	89 Pine Rd	Orlando	FL	32801	USA	E9G7B3C6D2	G4567	Immunization administration for pediatric patient.
CLM000006	blank	120	blank	PAT0006	PRV0008	2023-03-09	2023-03-11	92507	blank	F80.81	blank	1	blank	145	120	2023-03-30	PYR0006	paid	12	blank	blank	Noah	Martin	2015-07-23	male	245 Cedar Ave	St. Paul	MN	55101	USA	F2B7D6C9E4	G5678	Speech therapy session for expressive language disorder.
CLM000007	25	110	blank	PAT0007	PRV0009	2023-05-12	2023-05-13	99214	blank	G43.909	blank	1	blank	160	110	2023-05-31	PYR0007	paid	11	PRV0010	blank	Sophia	Miller	1997-11-18	female	901 Sunset Blvd	Los Angeles	CA	90001	USA	G1D2F3A4B5	G6789	Office visit for migraine evaluation and medication adjustment.
CLM000008	blank	45	blank	PAT0008	PRV0011	2023-06-21	2023-06-21	99211	blank	Z00.00	blank	1	blank	60	45	2023-07-05	PYR0008	paid	11	blank	blank	Lucas	Davis	2004-04-01	male	77 Broadway	New York	NY	10001	USA	H6B3E2F9A8	blank	Brief office visit for school physical clearance.
CLM000009	blank	160	I10	PAT0009	PRV0012	2023-07-02	2023-07-04	99385	blank	E11.9	blank	1	2	210	160	2023-07-21	PYR0009	paid	11	blank	blank	Olivia	Hernandez	1958-08-16	female	23 Elm St	Houston	TX	77002	USA	I3C6F2B8D7	G7890	Annual preventive exam. Diabetes and hypertension management.
CLM000010	blank	690	M54.5	PAT0010	PRV0013	2023-08-08	2023-08-10	99283	blank	R53.83	E11.9	1	2	920	690	2023-08-27	PYR0010	paid	23	PRV0014	PRV0015	William	Moore	1971-05-30	male	900 Maple St	Seattle	WA	98101	USA	J7C8B6F4D2	G8901	ER visit for acute fatigue and back pain. Multiple diagnostics performed.
CLM000011	25	80	blank	PAT0011	PRV0001	2023-03-04	2023-03-06	99213	blank	J10.1	blank	1	blank	115	80	2023-03-25	PYR0002	paid	11	blank	blank	Mason	White	1985-10-15	male	456 Spruce St	Boston	MA	02108	USA	K2F4B5D7C8	G9012	Follow-up for influenza with mild symptoms.
CLM000012	blank	125	blank	PAT0012	PRV0016	2023-11-15	2023-11-17	99385	blank	Z00.00	blank	1	blank	185	125	2023-12-02	PYR0004	paid	31	blank	blank	Isabella	Brown	1941-08-21	female	blank	blank	blank	blank	blank	L2E5A3B7C9	blank	Annual checkup for patient in long-term care facility.
CLM000013	blank	75	blank	PAT0013	PRV0017	2023-02-03	2023-02-04	99213	blank	J02.9	blank	1	blank	110	75	2023-02-22	PYR0011	paid	11	blank	blank	Elijah	Walker	1996-06-12	male	321 Birch St	Denver	CO	80202	USA	M7D4B2C9E1	G1345	Office visit for acute pharyngitis.
CLM000014	blank	140	Z00.00	PAT0014	PRV0018	2023-10-22	2023-10-23	80050	blank	E11.9	blank	1	2	210	140	2023-11-11	PYR0012	adjudicated	22	PRV0019	blank	Ava	King	1982-03-27	female	88 2nd Ave	Minneapolis	MN	55401	USA	N9E5F8B6C3	G2456	Lab panel for diabetes and routine checkup. Partial payment due to deductible.
CLM000015	TC	470	blank	PAT0015	PRV0020	2023-09-03	2023-09-04	70450	blank	M54.5	blank	1	blank	800	520	2023-09-24	PYR0013	adjudicated	22	blank	PRV0021	Ethan	Young	1966-12-03	male	12 Willow Dr	Denver	CO	80203	USA	O4F7G2C1D8	G3567	CT scan of spine for evaluation of chronic pain. Partial payment after coinsurance.
CLM000016	blank	90	blank	PAT0016	PRV0022	2023-02-14	2023-02-21	99214	blank	F41.9	blank	1	blank	135	90	2023-03-06	PYR0014	paid	11	blank	blank	Charlotte	Scott	2000-01-02	female	319 Central St	Boston	MA	02109	USA	P1B6F8C3D2	G4678	Office visit for anxiety management and medication review.
CLM000017	blank	108	Z00.00	PAT0017	PRV0023	2023-05-25	2023-05-27	92507	blank	F80.81	blank	1	2	130	108	2023-06-15	PYR0015	paid	12	blank	blank	Benjamin	Green	2013-03-19	male	56 Highland Rd	Philadelphia	PA	19103	USA	Q2B9A7F6C4	G5789	Speech therapy session for developmental delay.
CLM000018	blank	950	R53.83	PAT0018	PRV0024	2023-07-19	2023-07-21	99285	blank	I63.9	blank	1	2	1400	950	2023-08-09	PYR0016	paid	23	PRV0025	PRV0026	Henry	Hall	1949-11-06	male	124 River St	Minneapolis	MN	55402	USA	R8G2B5F4C1	G6890	ER visit for stroke evaluation. Full payment approved.
CLM000019	99	0	blank	PAT0019	PRV0027	2023-06-04	2023-06-04	99499	blank	R50.9	blank	1	blank	100	0.01	blank	PYR0017	denied	99	blank	blank	Amelia	Nelson	1976-10-14	female	44 Forest Ave	Miami	FL	33109	USA	S3D9F2B8C6	blank	Claim denied due to incomplete documentation.
CLM000020	blank	150	blank	PAT0020	PRV0028	2023-09-18	2023-09-22	80050	blank	Z00.00	blank	1	blank	215	150	2023-10-10	PYR0018	paid	22	blank	blank	Jack	Perez	1983-04-28	male	301 Willow St	Houston	TX	77003	USA	T6C4D9B3F7	G7901	Annual lab panel for adult preventive visit.

What the 105 rows show

from the 105-row sample

25 (cpt modifier 1) stands out: mean paid_amount is 100.1, against 554.5 for the rest.

105.0median paid_amount
3patient genders
4claim statuses
6place of service codes
11cpt codes
13patient address states

Mean paid_amount by cpt_modifier_134 rows

paid_amount105 rows, in bands of 200

Median 105.0, from 0.0 to 1,350.

diagnosis_code_228 rows with a value · 77 left blank

I107
E11.96
R53.835
Z00.005
M54.52
G43.9092
R551

34 columns by typefrom the column list below

string 25
integer 2
float 3
date 4

Columns

34 columns in three groups

blueprint · 34 columns
column	type	description	example
Text 25 columns
`claim_id`	string	Unique identifier for the medical claim transactionunique	CLM000001
`patient_id`	string	Unique identifier for the patient	PAT0001
`provider_id`	string	Unique identifier for the healthcare provider (physician, specialist, or facility)	PRV0001
`cpt_code`	string	Current Procedural Terminology code describing the medical procedure or service11 codes	99213
`cpt_modifier_1`	string	First CPT code modifier, if applicable4 1s · optional	25
`cpt_modifier_2`	string	Second CPT code modifier, if applicableoptional
`diagnosis_code_1`	string	Primary ICD diagnosis code associated with the claim	E11.9
`diagnosis_code_2`	string	Secondary ICD diagnosis code, if applicable7 2s · optional	R53.83
`diagnosis_code_3`	string	Tertiary ICD diagnosis code, if applicableoptional	E11.9
`payer_id`	string	Unique identifier for the insurance payer	PYR0001
`claim_status`	string	Current status of the claim (e.g., submitted, adjudicated, paid, denied)submitted · adjudicated · paid · denied · pending	paid
`place_of_service_code`	string	Code indicating the location where the service was provided6 codes	11
`referring_provider_id`	string	Unique identifier for the referring provider, if applicableoptional	PRV0003
`rendering_provider_id`	string	Unique identifier for the rendering provider, if different from main provideroptional	PRV0004
`patient_first_name`	string	Patient's first name	Ashley
`patient_last_name`	string	Patient's last name	Smith
`patient_gender`	string	Patient's gendermale · female · other · unknown	female
`patient_address_street`	string	Patient's street addressoptional	456 Market St
`patient_address_city`	string	Patient's cityoptional	San Francisco
`patient_address_state`	string	Patient's stateoptional	CA
`patient_address_postal_code`	string	Patient's postal codeoptional	94105
`patient_address_country`	string	Patient's countryoptional	USA
`insurance_policy_number`	string	Patient's insurance policy number	A3C2B9D8F7
`insurance_group_number`	string	Patient's insurance group numberoptional	G1234
`claim_notes`	string	Additional notes or remarks related to the claimoptional	Diabetes lab monitoring.
Numbers 5 columns
`diagnosis_pointer_1`	integer	Pointer linking the procedure to the primary diagnosis code1 to 4	1
`diagnosis_pointer_2`	integer	Pointer linking the procedure to the secondary diagnosis code1 to 4 · optional	2
`charge_amount`	float	Total amount charged for the service0 or more	120
`allowed_amount`	float	Amount allowed by the payer for the service0 or more	85
`paid_amount`	float	Amount actually paid to the provider0 or more	85
Dates and times 4 columns
`service_date`	date	Date when the medical service was provided	2023-03-15
`claim_submission_date`	date	Date when the claim was submitted	2023-03-17
`payment_date`	date	Date when payment was madeoptional	2023-04-04
`patient_date_of_birth`	date	Patient's date of birth	1988-06-22

Use it for

A healthcare dashboard
Paid_amount by cpt_modifier_1 and a breakdown of diagnosis_code_2. Excel, Power BI or Tableau.
Why do the 22 25 rows have a mean paid_amount of 100.1?
A root-cause class exercise
Hand out the rows and one question. The answer is in the data, not in the brief.
Claims105
CLM0000018525
CLM000002180—
CLM000003540TC
A software demo
Believable claims with patient_id, provider_id and service_date to fill a screen in front of a buyer.

This dataset105 rows34 columns

Yours1,000 rows34 columnspatient_address_street: UK only

blueprint · medical-claims-transactions-professional-cms-1500

Behind this dataset

Same schema. As many rows as you need.

These 105 rows came out of a blueprint — 34 columns with generation rules behind each one. Open it in Data Factory to retune a column, add your own, wire in foreign keys, and run it at the size you actually need.

Rules it was built with

Claim ID unique per submission
CMS-1500 form format for professional claims
Provider NPI (National Provider Identifier) required
Rendering provider, referring provider, facility documented
CPT/HCPCS procedure codes with modifiers
Units of service and charges per line
ICD-10-CM diagnosis codes (up to 12)
Diagnosis pointer linking procedure to diagnosis

Rows1,000 rows10,000 rows100,000 rows1,000,000 rows

Open the blueprint in Data Factory

1 credit per row. New accounts start with 25 free credits.

Exports: CSV, JSON, JSONL, Parquet, SQL, Excel, TSV, XML
Licence: yours to use, including commercially
API slug: medical-claims-transactions-professional-cms-1500

What should your data show?

No signup. No card.

Sample rows

What the 105 rows show

Columns

Use it for

A healthcare dashboard

A root-cause class exercise

A software demo

Make it yours.

Same schema. As many rows as you need.

More in Healthcare

What should your data show?