Outpatient (sample) |
OP claims data are for the calendar year ending 12/31/2008.
These reports are consistent with CMS Data Release policies.
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Statistics for the Top 20 Medical Diagnoses
ICD-9 diagnosis codes (formats: Word or PDF) / Definitions
| ICD-9 Code |
ICD-9 Description | Total Payment | Number Patient Claims | Average Charge | Average Cost | Average Payment | Total Outlier Amount |
National Average Charge |
|---|---|---|---|---|---|---|---|---|
| 41400 | COR ATH UNSP VSL NTV/GFT | $864,011 | 268 | $8,719 | $2,925 | $3,223 | $0 | $2,450 |
| 185 | MALIGN NEOPL PROSTATE | $777,055 | 311 | $9,828 | $1,989 | $2,498 | $0 | $5,234 |
| 99604 | MCH CMP AUTM MPLNT DFBRL | $698,305 | 42 | $44,831 | $22,807 | $16,626 | $6,299 | $23,333 |
| 78650 | CHEST PAIN NOS | $571,141 | 773 | $3,746 | $776 | $738 | $816 | $3,573 |
| 99601 | MALFUNC CARDIAC PACEMAKE | $569,769 | 77 | $16,142 | $7,780 | $7,399 | $0 | $13,180 |
| V711 | OBSV-SUSPCT MAL NEOPLASM | $567,139 | 903 | $3,338 | $481 | $628 | $0 | $4,238 |
| V7651 | SCREEN MALIG NEOP-COLON | $518,539 | 980 | $1,689 | $550 | $529 | $0 | $2,592 |
| V580 | RADIOTHERAPY ENCOUNTER | $499,776 | 184 | $10,489 | $1,933 | $2,716 | $0 | $10,733 |
| V5332 | FTNG AUTMTC DFIBRILLATOR | $498,591 | 30 | $40,575 | $20,396 | $16,619 | $0 | $27,165 |
| 72252 | LUMB/LUMBOSAC DISC DEGEN | $493,935 | 844 | $2,628 | $611 | $585 | $0 | $2,071 |
| 2113 | BENIGN NEOPLASM LG BOWEL | $476,183 | 641 | $2,619 | $840 | $742 | $2,192 | $2,777 |
| 78659 | CHEST PAIN NEC | $463,815 | 379 | $6,134 | $1,299 | $1,223 | $0 | $5,973 |
| 1749 | MALIGN NEOPL BREAST NOS | $411,088 | 261 | $5,559 | $1,313 | $1,575 | $0 | $3,609 |
| V5331 | FTNG CARDIAC PACEMAKER | $394,414 | 51 | $16,655 | $7,990 | $7,733 | $0 | $5,453 |
| 36610 | SENILE CATARACT NOS | $391,580 | 273 | $3,293 | $1,172 | $1,434 | $0 | $4,502 |
| 7802 | SYNCOPE AND COLLAPSE | $388,005 | 464 | $4,033 | $936 | $836 | $0 | $3,945 |
| 73313 | PATH FX VERTEBRAE | $374,176 | 112 | $8,356 | $3,505 | $3,340 | $968 | $8,797 |
| 28803 | DRUG INDUCED NEUTROPENIA | $371,531 | 181 | $6,602 | $2,291 | $2,052 | $0 | $4,874 |
| 78900 | ABDMNAL PAIN UNSPCF SITE | $359,354 | 813 | $2,496 | $460 | $442 | $0 | $2,560 |
| 72402 | SPINAL STENOSIS-LUMBAR | $351,560 | 522 | $2,917 | $723 | $673 | $0 | $2,699 |
| All Other | $21,571,834 | 35,340 | - | - | - | - | - | |
| Unclassified Services | $0 | 0 | - | - | - | - | - | |
| TOTAL FOR ALL CLAIMS | $31,611,801 | 43,449 | - | - | - | - | - |
Statistics for the Top 20 Ambulatory Payment Classifications (APCs)
APCs descriptions (formats: Excel or PDF) / Definitions
| APC Number |
APC Description | Total Payment | Number Patient Claims |
Units of Service | Average Charge |
Average Cost | Average Payment | National Average Charge |
|---|---|---|---|---|---|---|---|---|
| 0283 | Computed Tomography with Contrast | $1,274,881 | 4,934 | 4,934 | $1,505 | $220 | $258 | $1,782 |
| 0107 | Insertion of Cardioverter-Defibrillator | $1,223,659 | 62 | 62 | $4,804 | $973 | $19,736 | $12,898 |
| 0615 | Level 4 Emergency Visits | $972,566 | 3,984 | 3,988 | $621 | $230 | $243 | $801 |
| 0207 | Level III Nerve Injections | $965,785 | 1,430 | 2,303 | $656 | $221 | $419 | $1,134 |
| 0337 | Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast | $925,646 | 1,894 | 1,897 | $2,591 | $278 | $487 | $3,157 |
| 0332 | Computed Tomography without Contrast | $920,962 | 5,127 | 5,150 | $1,156 | $169 | $178 | $1,522 |
| 0143 | Lower GI Endoscopy | $899,143 | 1,813 | 1,814 | $1,250 | $420 | $495 | $1,747 |
| 0108 | Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads | $806,381 | 36 | 36 | $4,828 | $978 | $22,399 | $16,766 |
| 0412 | IMRT Treatment Delivery | $795,015 | 197 | 2,441 | $1,118 | $205 | $325 | $1,709 |
| 0301 | Level II Radiation Therapy | $785,546 | 642 | 5,922 | $426 | $78 | $132 | $650 |
| 0131 | Level II Laparoscopy | $733,884 | 266 | 266 | $2,781 | $936 | $2,758 | $5,159 |
| 0308 | Non-Myocardial Positron Emission Tomography (PET) imaging | $703,193 | 717 | 717 | $3,999 | $585 | $980 | $4,661 |
| 0616 | Level 5 Emergency Visits | $618,248 | 1,445 | 1,448 | $702 | $260 | $426 | $1,201 |
| 0655 | Insertion/Replacement/Conversion of a permanent dual chamber pacemaker | $532,348 | 66 | 66 | $3,430 | $1,155 | $8,065 | $8,578 |
| 0656 | Transcatheter Placement of Intracoronary Drug-Eluting Stents | $530,582 | 81 | 82 | $4,968 | $1,006 | $6,470 | $10,689 |
| 0246 | Cataract Procedures with IOL Insert | $527,288 | 372 | 372 | $1,473 | $496 | $1,417 | $2,858 |
| 0654 | Insertion/Replacement of a permanent dual chamber pacemaker | $521,491 | 82 | 82 | $2,796 | $941 | $6,359 | $6,687 |
| 0141 | Level I Upper GI Procedures | $518,501 | 1,289 | 1,289 | $893 | $300 | $402 | $1,437 |
| 9119 | Injection, pegfilgrastim 6mg | $514,244 | 206 | 253 | $6,957 | $2,439 | $2,032 | $8,508 |
| 0080 | Diagnostic Cardiac Catheterization | $465,229 | 233 | 233 | $2,802 | $567 | $1,996 | $5,660 |
| TOTAL FOR TOP 20 | $15,234,592 | 24,876 | 33,355 | - | - | - | - | |
| SERVICE MIX INDEX = 4.042 |
Search for Other APCs
Enter APC desired and statistics will appear in a new window.
(Only APCs representing more than 10 patients are reported.)
Statistics for the Top 20 Procedures
HCPCS descriptions (formats:
Excel or PDF) /
Definitions
CPT® descriptions are copyright AMA and can be ordered from the AMA
website.
Short CPT descriptions appear in Addendum B of the Federal Register as part of OPPS rulemaking
and on the
CMS website.
CPT ©2008 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use.
| HCPCS/CPT Code | HCPCS/CPT Description | Total Payment | Number Patient Claims | Units of Service | Average Charge | Average Cost | Average Payment | National Average Charge |
|---|---|---|---|---|---|---|---|---|
| 33240 | Insert pulse generator | $1,223,659 | 62 | 62 | $4,804 | $973 | $19,736 | $12,898 |
| 99284 | Emergency dept visit | $972,566 | 3,984 | 3,988 | $622 | $230 | $244 | $801 |
| 62311 | Inject spine l/s (cd) | $855,036 | 1,256 | 2,034 | $1,066 | $359 | $680 | $1,097 |
| 33249 | Eltrd/insert pace-defib | $806,381 | 36 | 36 | $4,828 | $978 | $22,399 | $16,766 |
| 77418 | Radiation tx delivery, imrt | $795,015 | 197 | 2,441 | $13,857 | $2,546 | $4,035 | $1,713 |
| 78815 | Pet image w/ct, skull-thigh | $690,247 | 704 | 704 | $4,000 | $585 | $980 | $4,680 |
| 99285 | Emergency dept visit | $618,248 | 1,445 | 1,448 | $703 | $260 | $427 | $1,201 |
| 70553 | Mri brain w/o & w/dye | $532,957 | 1,089 | 1,091 | $2,484 | $267 | $489 | $3,227 |
| 33208 | Insertion of heart pacemaker | $532,348 | 66 | 66 | $3,430 | $1,155 | $8,065 | $8,565 |
| 33213 | Insertion of pulse generator | $521,491 | 82 | 82 | $2,796 | $941 | $6,359 | $6,687 |
| 66984 | Cataract surg w/iol, 1 stage | $519,414 | 364 | 364 | $1,483 | $499 | $1,426 | $2,851 |
| J2505 | Injection, pegfilgrastim 6mg | $514,244 | 206 | 253 | $8,544 | $2,996 | $2,496 | $8,508 |
| G0290 | Drug-eluting stents, single | $502,166 | 74 | 74 | $5,135 | $1,040 | $6,786 | $11,085 |
| 74160 | Ct abdomen w/dye | $451,793 | 1,747 | 1,747 | $1,582 | $231 | $258 | $1,840 |
| 72193 | Ct pelvis w/dye | $449,811 | 1,741 | 1,741 | $1,444 | $211 | $258 | $1,738 |
| J1569 | Gammagard liquid injection | $440,495 | 201 | 13,990 | $8,559 | $3,001 | $2,191 | $136 |
| 77413 | Radiation treatment delivery | $423,602 | 332 | 3,200 | $3,756 | $690 | $1,275 | $647 |
| 70450 | Ct head/brain w/o dye | $412,752 | 2,285 | 2,305 | $1,109 | $162 | $180 | $1,459 |
| 99283 | Emergency dept visit | $397,763 | 3,241 | 3,247 | $347 | $128 | $122 | $488 |
| 43239 | Upper GI endoscopy, biopsy | $360,726 | 895 | 895 | $908 | $305 | $403 | $1,554 |
| TOTAL FOR TOP 20 | $12,020,714 | 20,007 | 39,768 | - | - | - | - |
Search for Other Procedures
Enter HCPCS/CPT code desired and statistics will appear in a new window.(Only procedures representing more than 10 patients are reported.)
Service Statistics
Services by Revenue Code / Definitions
| Service | Number Patient Claims | Units of Service | Average Charge | Average Cost | Average Payment | Service Mix Index - SMI |
|---|---|---|---|---|---|---|
| Pharmacy | 22,411 | 82,344 | $18 | $6 | $0 | 0.00 |
| IV Therapy | 3,257 | 4,466 | $152 | $40 | $63 | 1.06 |
| Medical Surgical Supplies | 39,356 | 127,555 | $100 | $58 | $0 | 0.00 |
| Laboratory | 68,260 | 78,990 | $57 | $13 | $9 | 0.22 |
| Laboratory - Pathological | 5,259 | 8,961 | $136 | $31 | $27 | 0.45 |
| Radiology - Diagnostic | 17,972 | 19,101 | $370 | $54 | $53 | 1.45 |
| Radiology - Therapeutic | 5,403 | 20,523 | $537 | $99 | $138 | 3.03 |
| Nuclear Medicine | 5,345 | 18,108 | $261 | $38 | $35 | 6.23 |
| CT Scan | 12,269 | 12,298 | $1,397 | $204 | $227 | 3.91 |
| Operating Room Services | 11,250 | 12,246 | $1,245 | $419 | $870 | 16.58 |
| Anesthesia | 4,005 | 128,835 | $11 | $3 | $0 | 0.00 |
| Blood Storage and Processing | 1,089 | 2,074 | $520 | $136 | $214 | 3.59 |
| Other Imaging Services | 3,035 | 3,039 | $1,434 | $210 | $287 | 5.40 |
| Respiratory Services | 1,632 | 5,387 | $40 | $20 | $24 | 0.41 |
| Physical Therapy | 626 | 1,321 | $103 | $39 | $31 | 0.00 |
| Occupational Therapy | 70 | 152 | $101 | $50 | $38 | 0.00 |
| Speech-Language Pathology | 363 | 382 | $260 | $109 | $72 | 0.00 |
| Emergency Room | 10,255 | 10,289 | $496 | $184 | $209 | 2.92 |
| Pulmonary Function | 893 | 1,580 | $96 | $157 | $25 | 0.94 |
| Cardiology | 3,026 | 3,031 | $698 | $183 | $199 | 5.77 |
| Cardiac Cath Lab | 1,654 | 1,657 | $1,634 | $331 | $2,094 | 116.50 |
| Magnetic Resonance Technology (MRT) | 3,098 | 3,106 | $2,345 | $252 | $424 | 7.16 |
| Drugs Requiring Specific Identification | 27,126 | 860,169 | $9 | $3 | $2 | 0.39 |
| Recovery Room | 8,055 | 244,279 | $13 | $4 | $0 | 0.00 |
| EKG/ECG (Electrocardiogram) | 6,243 | 7,673 | $215 | $17 | $26 | 0.44 |
| EEG (Electroencephalogram) | 151 | 151 | $405 | $89 | $137 | 2.30 |
| Gastrointestinal Servuces | 29 | 29 | $1,235 | $323 | $224 | 3.73 |
| Observation Room | 2,197 | 57,708 | $36 | $9 | $0 | 0.84 |
| Treatment Room | 290 | 327 | $102 | $27 | $56 | 0.95 |
| Psychiatric / Psychological Treatments | 161 | 163 | $547 | $174 | $197 | 3.30 |
| Psychiatric / Psychological Services | 25 | 199 | $112 | $76 | $54 | 1.05 |
| Other Diagnostic Services | 4,808 | 5,687 | $754 | $137 | $127 | 2.16 |
| Other Therapeutic Services | 4,925 | 6,017 | $134 | $35 | $38 | 0.69 |
| Other Therapeutic - Education / Training | 20 | 247 | $78 | $20 | $1 | 0.00 |
| Other Therapeutic - Cardiac Rehab | 171 | 1,227 | $126 | $33 | $34 | 0.57 |
| Unclassified | 1,032 | 1,178 | $16 | $3 | $10 | 0.39 |