Outpatient Utilization

Based on Medicare OPPS claims data

  • Medicare OPPS claims data are for calendar year ending 12/31/2025 (Proposed rule OPPS).
  • These reports are consistent with CMS cell size suppression policy.

Sample Hospital

Louisville, KY  11111
CMS Certification Number: 000000
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ICD
Drill down to more granular utilization statistics for ICD diagnoses and procedures
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Statistics for the Top 20 Medical Diagnoses

ICD-10 Diagnosis Codes

ICD-10
Code
ICD-10 Description Total Payment Number Patient Claims Average Charge Average Cost Average Payment Total Outlier
Amount
National Average Charge
Z5112 Encounter for antineoplastic immunotherapy $42,634,811 3,917 $63,048 $9,830 $10,885 $32,862 $50,880
Z5111 Encounter for antineoplastic chemotherapy $18,000,927 5,156 $23,759 $3,628 $3,491 $10,151 $27,954
Z510 Encounter for antineoplastic radiation therapy $4,891,466 6,276 $4,241 $593 $779 $4,686 $17,868
M810 Age-related osteoporosis w/o current pathological fracture $3,733,996 2,984 $7,253 $1,111 $1,251 $0 $3,557
G7000 Myasthenia gravis without (acute) exacerbation $2,966,915 200 $100,214 $15,822 $14,835 $0 $43,311
M1711 Unilateral primary osteoarthritis, right knee $2,580,511 279 $102,819 $16,437 $9,249 $605,676 $22,848
I480 Paroxysmal atrial fibrillation $2,405,051 637 $36,051 $8,581 $3,776 $42,940 $11,896
C61 Malignant neoplasm of prostate $2,392,287 1,375 $17,056 $2,414 $1,740 $54,023 $9,092
Z1211 Encounter for screening for malignant neoplasm of colon $2,308,111 2,014 $8,078 $1,427 $1,146 $12,179 $8,593
G8929 Other chronic pain $2,255,666 2,981 $5,613 $860 $757 $9,531 $3,952
I4819 Other persistent atrial fibrillation $1,925,976 339 $53,932 $12,722 $5,681 $41,601 $32,556
M1712 Unilateral primary osteoarthritis, left knee $1,896,693 214 $97,287 $15,800 $8,863 $437,521 $23,131
M1611 Unilateral primary osteoarthritis, right hip $1,729,236 229 $82,557 $13,213 $7,551 $488,757 $29,377
G35 Multiple sclerosis $1,500,644 814 $13,384 $1,866 $1,844 $0 $23,562
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,467,550 720 $22,432 $3,091 $2,038 $75,627 $8,262
M1612 Unilateral primary osteoarthritis, left hip $1,402,902 187 $80,786 $12,813 $7,502 $364,474 $29,920
G3184 Mild cognitive impairment of uncertain or unknown etiology $1,233,520 1,304 $7,060 $957 $946 $0 $3,591
C7A8 Other malignant neuroendocrine tumors $1,212,305 362 $27,988 $4,222 $3,349 $0 $21,408
M12811 Oth specific arthropathies, NEC, right shoulder $1,107,401 114 $102,394 $16,891 $9,714 $121,075 $20,395
M19012 Primary osteoarthritis, left shoulder $1,061,959 92 $115,161 $18,794 $11,543 $112,834 $19,754
  All Other $102,682,798 117,899 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $201,390,725 148,093 - - - - -

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  • (Only ICDs representing more than 10 patients are reported.)

Statistics for the Top 20 Ambulatory Payment Classifications (APCs)

APC
Number
APC Description Total Payment Number
Patient
Claims
Units of Service Average
Charge
Average Cost Average Payment National Average Charge
5115 Level 5 Musculoskeletal Procedures $6,613,652 576 576 $18,149 $2,517 $11,482 $25,708
5116 Level 6 Musculoskeletal Procedures $5,525,193 334 334 $20,071 $2,784 $16,542 $24,140
5213 Level 3 Electrophysiologic Procedures $5,014,659 228 228 $51,108 $4,022 $21,994 $61,601
5012 Clinic Visits and Related Services $4,089,520 37,611 39,417 $148 $56 $104 $247
8011 Comprehensive Observation Services $3,738,396 1,567 1,568 $1,921 $371 $2,384 $3,912
5193 Level 3 Endovascular Procedures $2,980,447 292 292 $25,219 $2,490 $10,207 $32,088
5694 Level 4 Drug Administration $2,625,229 7,753 8,752 $809 $119 $300 $1,441
5693 Level 3 Drug Administration $2,421,958 12,730 12,790 $658 $91 $189 $748
5524 Level 4 Imaging without Contrast $2,355,908 4,755 4,763 $4,786 $664 $495 $3,582
5114 Level 4 Musculoskeletal Procedures $2,291,194 359 359 $8,460 $1,173 $6,382 $17,211
5623 Level 3 Radiation Therapy $2,233,193 4,153 4,265 $2,923 $405 $524 $5,303
5594 Level 4 Nuclear Medicine and Related Services $2,220,762 1,686 1,686 $10,666 $1,426 $1,317 $9,418
5024 Level 4 Type A ED Visits $2,209,817 5,747 5,758 $1,788 $346 $384 $2,882
5572 Level 2 Imaging with Contrast $2,063,684 6,499 6,600 $5,792 $223 $313 $5,798
5312 Level 2 Lower GI Procedures $1,731,523 1,456 1,786 $3,769 $523 $969 $4,308
5232 Level 2 ICD and Similar Procedures $1,684,477 58 58 $28,985 $3,976 $29,043 $64,792
5442 Level 2 Nerve Injections $1,637,291 2,628 2,631 $3,732 $518 $622 $3,120
5374 Level 4 Urology and Related Services $1,520,648 489 489 $9,176 $1,273 $3,110 $11,885
5362 Level 2 Laparoscopy and Related Services $1,498,050 161 161 $42,839 $5,942 $9,305 $30,710
5593 Level 3 Nuclear Medicine and Related Services $1,484,240 1,259 1,259 $6,819 $912 $1,179 $6,394
  TOTAL FOR TOP 20 $55,939,841 90,341 93,772 - - - -
  SERVICE MIX INDEX = 5.872        

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  • Enter APC desired and statistics will appear in a new window.
  • (Only APCs representing more than 10 patients are reported.)
ASC
View characteristics, claims and quality data for Ambulatory Surgery Centers.
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Service Statistics

Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 34,882 398,146 $14 $2 $0 0.00
IV Therapy 34,873 46,547 $498 $69 $81 1.14
Medical Surgical Supplies 30,708 83,432 $3,454 $746 $5 74.67
Laboratory 263,025 304,445 $300 $16 $3 2.01
Laboratory - Pathological 4,216 7,984 $748 $38 $12 3.77
Radiology - Diagnostic 19,769 21,154 $726 $97 $56 1.39
Radiology - Therapeutic 26,852 30,978 $1,395 $194 $275 3.84
Nuclear Medicine 8,035 16,685 $1,730 $233 $200 10.97
CT Scan 26,256 26,343 $4,040 $110 $145 2.72
Operating Room Services 24,610 25,560 $5,563 $772 $1,918 31.07
Anesthesia 10,084 575,885 $36 $5 $0 0.00
Blood Storage and Processing 1,425 1,730 $1,418 $197 $283 3.62
Other Imaging Services 12,095 12,133 $2,387 $319 $274 5.74
Respiratory Services 1,897 4,136 $410 $48 $58 1.17
Physical Therapy 6,108 10,245 $313 $77 $39 1.77
Occupational Therapy 2,531 3,939 $304 $54 $31 0.00
Speech-Language Pathology 899 1,116 $696 $128 $73 0.00
Emergency Room 14,267 14,305 $1,721 $333 $549 7.18
Pulmonary Function 2,624 3,700 $523 $73 $58 1.77
Cardiology 9,596 9,609 $3,947 $548 $279 6.20
Cardiac Cath Lab 1,386 1,426 $27,651 $2,176 $5,966 123.60
Clinic 37,924 39,774 $152 $58 $104 1.46
Magnetic Resonance Technology (MRT) 8,891 8,938 $5,645 $284 $257 4.03
Drugs Requiring Specific Identification 141,186 9,598,312 $63 $10 $10 0.00
Recovery Room 9,682 715,820 $21 $5 $0 0.00
EKG/ECG (Electrocardiogram) 11,718 14,875 $415 $31 $10 0.74
EEG (Electroencephalogram) 246 249 $1,649 $224 $234 3.51
Gastrointestinal Services 18 18 $2,261 $314 $203 5.27
Observation Room 2,976 83,478 $74 $10 $0 0.00
Treatment Room 1,733 1,808 $690 $262 $212 3.08
Lithotripsy 165 165 $20,384 $2,827 $2,895 38.68
Other Diagnostic Services 7,117 7,350 $1,581 $214 $174 3.11
Other Therapeutic Services 23 27 $260 $34 $10 0.67
Other Therapeutic - Cardiac Rehab 722 5,256 $259 $98 $114 1.41
Unclassified 1,099 1,123 $202 $40 $38 0.94
Ambulatory Surgical Care 0 0 $0 $0 $0 0.00
Audiology 0 0 $0 $0 $0 0.00
Blood Products 0 0 $0 $0 $0 0.00
Cast Room 0 0 $0 $0 $0 0.00
Labor & Delivery 0 0 $0 $0 $0 0.00
Oncology 0 0 $0 $0 $0 0.00
Other Therapeutic - Education / Training 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Services 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Treatments 0 0 $0 $0 $0 0.00