When planning sales territories, one benchmark to consider that could be valuable for laboratory sales teams is Medicare Claims. If you can analyze Medicare claims in a very specific area, it will provide you with a wealth of information about the overall health of the population, the demographics, and its health needs.
With those information, you can better position your laboratory offerings and create sales territories that is more likely to hike revenue.
Why Medicare Claims Data?
One powerful — and often underused — resource for this is Medicare claims data. It provides a clear source of information about the health needs of a particular population. If you have this data and incorporate it into territory planning, laboratory sales teams can focus efforts on the highest-potential accounts, streamline travel, and improve quota attainment.
With Medicare Claims Data, a general outreach list can be turned into a precise, high-value prospect map for structuring effective sales territories. For laboratory sales, can be the difference between incremental growth and missed opportunities.
An image showing a team holding a tablet showing information. Laboratories and diagnostics can use Medicare claims data to map out sales territories.
Why Territory Planning Matters for Laboratory Sales Teams
Having a well-designed sales territory plan ensures that lab sales representatives are covering the right mix of accounts to maximize revenue. Without it, reps risk overlapping efforts, or may end up chasing low-value leads, or missing high-referral practices entirely.
The key benefits of optimized territory planning are:
- Balanced workloads between reps
- Reduced travel time and costs
- Increased face time with high-value prospects
- Improved account coverage and relationship depth
For laboratories — particularly those serving specialty physicians, hospitals, and diagnostic centers — the stakes are often higher. Missed coverage often means losing test volume to competitors.
How to Exactly Use Medicare Claims for Territory Planning
Medicare claims data provides a granular view of testing and referral activity across the U.S. Fortunately, these datasets are publicly available from CMS (Centers for Medicare & Medicaid Services) and it provides a wealth of information such as procedure volumes by provider, location, and specialty.
How labs can use Medicare claims data in territory planning:
Identify High-Volume Providers
For example, you can filter claims for CPT codes relevant to your lab’s tests (e.g., molecular pathology, toxicology, genetic testing). High-volume providers become primary targets for rep visits.
Spot Referral Patterns
Medicare claims can reveal which physicians are referring to specific labs. This helps in targeting referral sources that may be sending business to competitors.
Segment by Specialty & Geography
Assess Market Share
Steps to Build Data-Driven Sales Territories
- Define Your Ideal Customer Profile (ICP) – For labs, the ICP might include practice size, specialty, payer mix, and historical referral behavior.
- Map the Market Using Claims Data – Overlay high-potential accounts on a geographic map to visualize density.
- Balance Territories by Opportunity – Ensure each rep’s territory has a comparable total potential test volume — not just equal numbers of accounts.
- Integrate with CRM & Route Planning Tools – Load the territory data into your CRM and connect it to mapping software so reps can plan travel efficiently.
- Review & Adjust Quarterly – Healthcare markets shift, especially with policy changes or competitive moves, so review claims data regularly to adjust territory boundaries.
Real-World Example: Molecular Diagnostics Expansion
Recommended External Resources
FAQs: Planning Sales Territories for Laboratory Sales Teams
Q1: What CPT codes should I target for Medicare claims analysis?
Focus on codes related to your lab’s test offerings. For example, genetic testing labs might track codes 81211–81220, while toxicology labs may track 80305–80307.
Q2: How often should I refresh Medicare claims data for territory planning?
At least annually, but quarterly updates are ideal for tracking emerging referral trends and market shifts.
Q3: Can Medicare claims data show commercial payer activity?
No. Medicare data only covers Medicare beneficiaries. Combining it with commercial payer data (via tools like Voyager) gives a more complete market view.
Q4: How do I handle overlapping territories when multiple reps want the same account?
Assign accounts based on historical relationships, potential revenue, and travel efficiency, not just geography.
Q5: Is there a risk of violating HIPAA when using Medicare claims?
No. Publicly available Medicare claims data is aggregated and any identification is removed. However, you should still observe HIPAA rules when handling medical data.
