Outpatient Utilization

Based on Medicare OPPS claims data

  • Medicare OPPS claims data are for calendar year ending 12/31/2024 (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 $38,852,494 3,893 $54,553 $10,126 $9,980 $0 $47,840
Z5111 Encounter for antineoplastic chemotherapy $19,109,225 5,288 $23,498 $4,265 $3,614 $9,042 $25,689
Z510 Encounter for antineoplastic radiation therapy $5,552,805 6,044 $4,618 $715 $919 $0 $17,727
C61 Malignant neoplasm of prostate $3,228,498 1,431 $17,898 $2,708 $2,256 $46,704 $8,510
G7000 Myasthenia gravis without (acute) exacerbation $3,128,445 202 $100,747 $18,972 $15,487 $0 $40,804
M1712 Unilateral primary osteoarthritis, left knee $2,874,704 283 $103,188 $18,155 $10,158 $812,168 $22,952
M810 Age-related osteoporosis w/o current pathological fracture $2,774,707 2,567 $6,064 $1,102 $1,081 $0 $3,149
G35 Multiple sclerosis $2,254,968 973 $14,226 $2,383 $2,318 $0 $22,283
M1711 Unilateral primary osteoarthritis, right knee $2,217,053 209 $104,993 $18,519 $10,608 $613,716 $22,541
Z1211 Encounter for screening for malignant neoplasm of colon $2,163,515 2,054 $7,391 $1,410 $1,053 $0 $7,998
I480 Paroxysmal atrial fibrillation $1,659,121 581 $24,458 $4,570 $2,856 $11,797 $10,217
M1611 Unilateral primary osteoarthritis, right hip $1,630,889 224 $70,319 $12,543 $7,281 $265,103 $28,446
G8929 Other chronic pain $1,484,758 2,294 $4,646 $839 $647 $0 $3,703
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,482,015 707 $21,046 $2,822 $2,096 $55,855 $8,025
M12811 Oth specific arthropathies, NEC, right shoulder $1,167,610 123 $87,592 $15,095 $9,493 $66,479 $20,781
I4819 Other persistent atrial fibrillation $1,167,158 345 $30,458 $5,768 $3,383 $17,645 $26,818
G4733 Obstructive sleep apnea (adult) (pediatric) $1,163,576 1,559 $4,915 $839 $746 $5,892 $3,990
J4550 Severe persistent asthma, uncomplicated $1,115,153 295 $20,852 $3,906 $3,780 $0 $11,896
M1612 Unilateral primary osteoarthritis, left hip $1,113,344 173 $63,473 $11,300 $6,436 $194,657 $28,905
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,009,437 150 $69,175 $9,539 $6,730 $93,222 $44,975
  All Other $97,572,342 113,552 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $192,721,817 142,947 - - - - -

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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 $6,855,101 620 620 $18,073 $3,206 $11,057 $23,959
5116 Level 6 Musculoskeletal Procedures $5,132,351 323 323 $17,912 $3,178 $15,890 $22,837
8011 Comprehensive Observation Services $3,828,830 1,637 1,637 $1,720 $346 $2,339 $3,626
5012 Clinic Visits and Related Services $3,674,431 34,961 36,889 $132 $68 $100 $233
5213 Level 3 Electrophysiologic Procedures $3,393,836 167 167 $48,215 $4,132 $20,322 $58,903
5193 Level 3 Endovascular Procedures $2,824,351 299 299 $22,495 $2,791 $9,446 $30,040
5694 Level 4 Drug Administration $2,598,264 7,999 8,950 $763 $128 $290 $1,354
5524 Level 4 Imaging without Contrast $2,330,830 4,928 4,946 $4,622 $705 $471 $3,417
5594 Level 4 Nuclear Medicine and Related Services $2,321,274 1,734 1,734 $10,059 $1,424 $1,339 $9,034
5114 Level 4 Musculoskeletal Procedures $2,235,475 369 466 $6,265 $1,111 $4,797 $15,708
5693 Level 3 Drug Administration $2,109,542 11,528 11,550 $624 $95 $183 $702
5623 Level 3 Radiation Therapy $2,069,726 3,885 4,081 $2,753 $420 $507 $4,966
5024 Level 4 Type A ED Visits $2,034,108 5,382 5,383 $1,600 $322 $378 $2,654
5232 Level 2 ICD and Similar Procedures $1,808,743 64 64 $23,946 $4,248 $28,262 $61,266
5572 Level 2 Imaging with Contrast $1,751,162 5,500 5,509 $5,633 $230 $318 $5,814
5593 Level 3 Nuclear Medicine and Related Services $1,655,485 1,365 1,366 $6,538 $926 $1,212 $6,141
5312 Level 2 Lower GI Procedures $1,615,010 1,430 1,757 $3,553 $630 $919 $4,072
5442 Level 2 Nerve Injections $1,605,697 2,720 2,729 $3,523 $625 $588 $2,957
5362 Level 2 Laparoscopy and Related Services $1,480,170 170 170 $39,057 $6,929 $8,707 $28,449
5374 Level 4 Urology and Related Services $1,453,026 489 489 $9,552 $1,512 $2,971 $11,248
  TOTAL FOR TOP 20 $52,777,412 85,570 89,129 - - - -
  SERVICE MIX INDEX = 5.876        

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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 33,398 114,425 $42 $8 $0 0.00
IV Therapy 32,237 43,495 $468 $71 $77 1.09
Medical Surgical Supplies 28,835 77,652 $2,973 $587 $4 94.25
Laboratory 250,455 288,599 $279 $16 $3 1.91
Laboratory - Pathological 4,169 8,147 $636 $35 $9 3.73
Radiology - Diagnostic 20,051 21,746 $703 $100 $53 1.42
Radiology - Therapeutic 26,709 30,854 $1,326 $202 $269 3.79
Nuclear Medicine 9,670 28,127 $1,324 $193 $190 11.60
CT Scan 30,173 31,478 $3,113 $89 $114 2.70
Operating Room Services 23,611 24,824 $5,200 $922 $1,887 31.26
Anesthesia 10,003 566,427 $34 $5 $0 0.00
Blood Storage and Processing 1,528 1,921 $1,364 $208 $272 3.53
Other Imaging Services 12,226 12,259 $2,261 $320 $277 6.13
Respiratory Services 1,851 4,122 $409 $55 $52 1.13
Physical Therapy 6,160 10,283 $293 $74 $39 1.72
Occupational Therapy 2,256 3,540 $284 $51 $31 0.00
Speech-Language Pathology 783 1,085 $638 $121 $57 4.45
Emergency Room 13,543 13,544 $1,540 $310 $560 7.51
Pulmonary Function 2,754 3,573 $539 $82 $60 2.14
Cardiology 9,824 9,835 $3,820 $583 $262 5.98
Cardiac Cath Lab 1,160 1,198 $27,426 $2,350 $5,721 109.43
Clinic 35,099 37,072 $133 $68 $100 1.45
Magnetic Resonance Technology (MRT) 10,079 10,231 $4,229 $222 $188 3.80
Drugs Requiring Specific Identification 142,098 8,641,406 $64 $12 $10 0.00
Recovery Room 9,634 717,949 $20 $5 $0 0.00
EKG/ECG (Electrocardiogram) 11,815 15,030 $410 $29 $10 0.76
EEG (Electroencephalogram) 289 294 $1,575 $255 $226 3.47
Observation Room 3,049 83,981 $74 $11 $0 0.00
Treatment Room 1,955 2,032 $581 $299 $175 2.63
Lithotripsy 199 199 $19,288 $2,941 $2,771 38.01
Other Diagnostic Services 6,429 6,674 $1,492 $218 $171 3.12
Other Therapeutic - Cardiac Rehab 826 6,091 $244 $125 $114 1.44
Unclassified 1,220 1,256 $183 $45 $30 0.78
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
Gastrointestinal Services 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
Other Therapeutic Services 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