2026 Medicare Revenue Gap Report
The definitive analysis of missed Medicare revenue across all 50 states and 20 specialties — covering 1.2M providers and $93721.1M in Medicare payments.
Executive Summary
Total Providers Analyzed
1.2M
Total Medicare Payments
$93721.1M
Estimated Total Revenue Gap
$20186.0M
Top Gap Program
AWV
21.5% adoption vs 50% target
Key Finding: An estimated $20186.0M in Medicare revenue goes uncaptured annually across 1.2M providers. The largest contributor is underutilization of AWV — with a national adoption rate of just 21.5% against a target of 50%.
50-State Revenue Gap Comparison
| Rank | State | Grade | Providers | Avg Payment | Est. Missed Revenue |
|---|---|---|---|---|---|
| 1 | California | A | 93K | $123K | $2482.4M |
| 2 | New York | A | 80K | $79K | $1367.3M |
| 3 | Texas | A | 78K | $90K | $1523.8M |
| 4 | Florida | A | 77K | $115K | $1913.4M |
| 5 | Pennsylvania | A | 58K | $65K | $808.9M |
| 6 | Ohio | A | 48K | $51K | $529.8M |
| 7 | Illinois | A | 47K | $90K | $918.1M |
| 8 | North Carolina | A | 40K | $67K | $579.8M |
| 9 | Michigan | A | 40K | $51K | $433.5M |
| 10 | New Jersey | A | 37K | $105K | $829.6M |
| 11 | Massachusetts | A | 36K | $68K | $519.5M |
| 12 | Georgia | A | 33K | $70K | $497.3M |
| 13 | Virginia | A | 30K | $84K | $543.6M |
| 14 | Tennessee | A | 27K | $74K | $435.3M |
| 15 | Minnesota | A | 26K | $39K | $218.2M |
| 16 | Washington | A | 26K | $59K | $328.2M |
| 17 | Indiana | A | 25K | $63K | $333.5M |
| 18 | Maryland | A | 24K | $111K | $582.9M |
| 19 | Wisconsin | A | 24K | $51K | $269.8M |
| 20 | Arizona | A | 24K | $129K | $669.0M |
| 21 | Missouri | A | 23K | $60K | $300.1M |
| 22 | Colorado | A | 20K | $67K | $293.8M |
| 23 | South Carolina | A | 19K | $90K | $367.9M |
| 24 | Kentucky | A | 18K | $56K | $212.8M |
| 25 | Connecticut | A | 17K | $55K | $197.3M |
| 26 | Alabama | A | 17K | $79K | $284.8M |
| 27 | Louisiana | A | 16K | $65K | $227.5M |
| 28 | Oregon | A | 14K | $54K | $164.1M |
| 29 | Oklahoma | A | 13K | $85K | $235.2M |
| 30 | Iowa | A | 12K | $64K | $164.7M |
| 31 | Kansas | A | 11K | $85K | $211.5M |
| 32 | Arkansas | A | 10K | $89K | $195.0M |
| 33 | Mississippi | A | 10K | $100K | $205.2M |
| 34 | Utah | A | 9K | $61K | $123.2M |
| 35 | Nevada | A | 9K | $108K | $204.8M |
| 36 | Nebraska | A | 8K | $71K | $126.5M |
| 37 | West Virginia | A | 7K | $50K | $74.7M |
| 38 | New Hampshire | A | 7K | $51K | $76.3M |
| 39 | Maine | A | 6K | $35K | $49.0M |
| 40 | Idaho | A | 6K | $76K | $104.0M |
| 41 | New Mexico | A | 6K | $58K | $79.0M |
| 42 | Rhode Island | A | 5K | $48K | $50.7M |
| 43 | Montana | A | 5K | $54K | $54.0M |
| 44 | Delaware | A | 5K | $95K | $93.5M |
| 45 | South Dakota | A | 4K | $54K | $50.8M |
| 46 | Hawaii | A | 4K | $56K | $47.9M |
| 47 | North Dakota | A | 4K | $49K | $40.5M |
| 48 | District of Columbia | A | 4K | $61K | $48.7M |
| 49 | Puerto Rico | A | 4K | $15K | $11.9M |
| 50 | Alaska | A | 3K | $71K | $43.3M |
| 51 | Vermont | A | 3K | $41K | $24.4M |
| 52 | Wyoming | A | 2K | $62K | $28.8M |
| 53 | Guam | A | 207 | $80K | $3.6M |
| 54 | Virgin Islands | A | 172 | $62K | $2.3M |
| 55 | ZZ | A | 68 | $22K | $316K |
| 56 | AE | A | 62 | $204K | $2.7M |
| 57 | AP | A | 56 | $27K | $325K |
| 58 | XX | A | 28 | $110K | $665K |
| 59 | Northern Mariana Islands | A | 26 | $33K | $184K |
| 60 | AA | A | 15 | $42K | $135K |
| 61 | American Samoa | A | 1 | $6K | $1K |
| 62 | FM | A | 1 | $34K | $7K |
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NPIxray. (2026). 2026 Medicare Revenue Gap Report: 50-State Analysis. NPIxray. https://npixray.com/reports/2026-medicare-revenue-gap
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I just reviewed the 2026 Medicare Revenue Report Card for National. Key findings: - Overall Grade: N/A - Estimated Missed Revenue: $20186.0M - Low adoption of care management programs (CCM, RPM, BHI, AWV) The data comes directly from CMS public records — every medical practice can see exactly how much revenue they're leaving on the table. See the full National report card:
https://npixray.comhttps://npixray.com/reports/2026-medicare-revenue-gap
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