• Medicare OPPS claims data are for calendar year ending 12/31/2018 (Final 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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Outpatient Utilization

Based on Medicare OPPS claims data

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
Z5111 Encounter for antineoplastic chemotherapy $16,286,945 3,549 $23,681 $4,484 $4,589 $18,440 $19,445
Z5112 Encounter for antineoplastic immunotherapy $15,106,045 1,791 $34,232 $6,844 $8,434 $5,102 $30,412
G35 Multiple sclerosis $4,899,668 887 $23,025 $4,428 $5,524 $0 $13,620
Z510 Encounter for antineoplastic radiation therapy $2,875,912 579 $21,929 $3,243 $4,967 $0 $14,363
T82868A Thrombosis due to vascular prosth dev/grft, init $2,296,106 272 $38,929 $8,013 $8,442 $11,566 $29,259
T82858A Stenosis of other vascular prosth dev/grft, init $2,105,338 452 $22,278 $4,207 $4,658 $9,324 $22,404
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,857,941 325 $48,966 $6,123 $5,717 $57,234 $37,521
G8929 Other chronic pain $1,655,301 2,641 $4,155 $682 $627 $0 $2,598
Z1211 Encounter for screening for malignant neoplasm of colon $1,399,839 1,704 $4,921 $818 $822 $2,018 $5,186
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,394,220 1,274 $9,058 $1,300 $1,094 $11,791 $6,108
C61 Malignant neoplasm of prostate $1,336,761 1,326 $6,404 $887 $1,008 $13,148 $5,041
R079 Chest pain, unspecified $1,326,500 1,044 $11,830 $1,394 $1,271 $15,602 $7,129
R0789 Other chest pain $1,189,694 1,018 $11,249 $1,237 $1,169 $21,111 $8,524
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $835,145 43 $118,944 $19,783 $19,422 $2,776 $17,900
I480 Paroxysmal atrial fibrillation $832,763 703 $10,362 $1,851 $1,185 $5,194 $4,473
R55 Syncope and collapse $832,608 713 $10,963 $1,124 $1,168 $12,092 $7,994
D593 Hemolytic-uremic syndrome $777,395 28 $118,283 $24,176 $27,764 $0 $84,137
C220 Liver cell carcinoma $755,117 229 $22,563 $3,620 $3,297 $34,351 $11,198
D839 Common variable immunodeficiency, unspecified $707,982 270 $18,613 $3,731 $2,622 $0 $14,061
G4733 Obstructive sleep apnea (adult) (pediatric) $704,833 1,519 $1,931 $331 $464 $0 $2,589
  All Other $82,677,620 109,036 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $141,853,733 129,403 - - - - -

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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
8011 Comprehensive Observation Services $5,627,170 2,687 2,689 $1,708 $235 $2,093 $2,412
5193 Level 3 Endovascular Procedures $5,054,211 540 541 $17,545 $2,074 $9,342 $19,390
1490 Inj pembrolizumab $3,902,066 441 111,194 $150 $31 $35 $185
9453 Injection, nivolumab $3,526,168 445 180,420 $84 $17 $20 $106
5012 Clinic Visits and Related Services $3,160,465 25,514 30,801 $136 $79 $103 $182
9494 Injection, ocrelizumab $2,981,737 110 55,813 $188 $39 $53 $207
0849 Rituximab injection $2,682,165 346 3,443 $2,856 $593 $779 $3,461
5192 Level 2 Endovascular Procedures $2,596,568 570 570 $12,699 $1,815 $4,555 $13,590
5694 Level 4 Drug Administration $2,527,000 5,509 9,421 $575 $91 $268 $967
5232 Level 2 ICD and Similar Procedures $2,491,290 89 89 $19,850 $3,021 $27,992 $42,602
5115 Level 5 Musculoskeletal Procedures $2,451,044 269 269 $9,403 $1,431 $9,112 $13,989
5693 Level 3 Drug Administration $2,361,630 10,473 13,789 $459 $65 $171 $463
9119 Injection, pegfilgrastim 6mg $2,293,612 570 696 $19,457 $4,037 $3,295 $20,072
5593 Level 3 Nuclear Medicine and Related Services $2,288,283 2,121 2,121 $4,857 $644 $1,079 $4,728
9214 Bevacizumab injection $2,265,918 379 39,965 $253 $53 $57 $321
5114 Level 4 Musculoskeletal Procedures $2,236,214 446 446 $6,708 $1,021 $5,014 $10,801
5524 Level 4 Imaging without Contrast $2,230,777 5,110 5,115 $4,324 $614 $436 $2,561
5024 Level 4 Type A ED Visits $2,228,991 7,011 7,120 $1,578 $217 $313 $1,734
5594 Level 4 Nuclear Medicine and Related Services $1,900,111 1,533 1,533 $7,550 $1,000 $1,239 $6,663
1613 Trastuzumab injection $1,879,461 310 19,330 $325 $68 $97 $408
  TOTAL FOR TOP 20 $56,684,881 64,473 485,365 - - - -
  SERVICE MIX INDEX = 5.617        

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

 

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Service Statistics

Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 23,870 51,735 $52 $11 $0 0.00
IV Therapy 37,441 68,838 $340 $48 $51 1.08
Medical Surgical Supplies 38,901 87,987 $1,316 $299 $6 51.87
Oncology 15 17 $662 $94 $53 2.51
Laboratory 283,162 355,503 $205 $12 $2 1.71
Laboratory - Pathological 9,946 17,150 $481 $28 $5 2.88
Radiology - Diagnostic 26,096 27,362 $530 $70 $46 1.36
Radiology - Therapeutic 14,479 29,882 $911 $129 $231 3.57
Nuclear Medicine 9,637 15,644 $1,296 $172 $202 11.69
CT Scan 26,133 26,248 $2,914 $81 $143 3.08
Operating Room Services 27,924 31,153 $3,423 $521 $1,338 23.16
Anesthesia 10,926 567,238 $26 $4 $0 0.00
Blood Storage and Processing 1,504 2,921 $1,007 $143 $241 3.45
Other Imaging Services 10,295 10,333 $1,750 $232 $235 6.03
Respiratory Services 4,416 9,244 $277 $31 $34 1.14
Physical Therapy 8,882 11,613 $136 $35 $11 0.00
Occupational Therapy 2,475 3,084 $134 $23 $13 0.00
Speech-Language Pathology 2,639 2,855 $174 $28 $17 4.77
Emergency Room 19,678 19,805 $1,538 $212 $528 7.91
Pulmonary Function 2,608 3,082 $387 $55 $40 2.69
Cardiology 11,470 11,478 $3,246 $461 $214 6.20
Cardiac Cath Lab 1,299 1,324 $20,889 $1,629 $4,297 81.37
Clinic 25,639 30,993 $137 $79 $103 1.46
Magnetic Resonance Technology (MRT) 8,462 8,513 $4,050 $190 $273 4.84
Drugs Requiring Specific Identification 181,567 6,918,774 $34 $7 $7 0.74
Recovery Room 10,714 792,950 $15 $3 $0 0.00
EKG/ECG (Electrocardiogram) 17,046 20,910 $346 $20 $7 0.93
EEG (Electroencephalogram) 501 539 $1,376 $215 $218 4.98
Observation Room 4,966 165,677 $65 $9 $0 0.00
Treatment Room 3,334 4,113 $288 $167 $72 2.13
Lithotripsy 168 168 $14,478 $2,057 $3,033 47.13
Other Diagnostic Services 8,440 8,675 $1,191 $162 $172 3.34
Other Therapeutic Services 103 589 $233 $26 $50 0.71
Other Therapeutic - Cardiac Rehab 975 6,685 $184 $107 $105 1.48
Unclassified 3,003 3,107 $135 $34 $32 0.64
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
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