• Medicare OPPS claims data are for calendar year ending 12/31/2015 (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-9 Diagnosis Codes for encounters 01/01/2015 - 09/30/2015

ICD-9
Code
ICD-9 Description Total Payment Number Patient Claims Average Charge Average Cost Average Payment Total Outlier
Amount
National Average Charge
V5811 Antineoplastic chemo enc $12,202,776 2,588 $19,693 $4,173 $4,715 $2,745 $15,289
V5812 Immunotherapy encounter $4,167,886 467 $30,418 $6,796 $8,925 $716 $20,338
340 Multiple sclerosis $3,052,440 895 $13,527 $2,882 $3,411 $37,581 $5,653
V580 Radiotherapy encounter $2,333,824 642 $16,704 $2,648 $3,635 $0 $13,806
99673 Comp-ren dialys dev/grft $2,074,167 531 $19,517 $4,109 $3,906 $8,084 $17,700
41401 Crnry athrscl natve vssl $1,611,010 562 $21,943 $3,069 $2,867 $35,025 $12,509
V5332 Ftng autmtc dfibrillator $1,367,380 61 $104,274 $23,133 $22,416 $0 $28,659
78650 Chest pain NOS $1,341,931 1,007 $10,834 $1,466 $1,333 $7,457 $5,741
78659 Chest pain NEC $1,171,849 952 $10,092 $1,334 $1,231 $7,220 $8,673
33829 Chronic pain NEC $1,026,588 1,692 $2,846 $460 $607 $2,340 $1,946
V7651 Screen malig neop-colon $807,783 1,121 $4,551 $789 $721 $1,200 $4,335
7140 Rheumatoid arthritis $759,730 228 $12,061 $2,693 $3,332 $1,348 $4,276
4148 Chr ischemic hrt dis NEC $722,751 114 $39,578 $8,536 $6,340 $7,510 $13,365
V5331 Ftng cardiac pacemaker $667,448 82 $39,349 $8,047 $8,140 $8,346 $8,227
1749 Malign neopl breast NOS $661,548 903 $4,332 $654 $733 $3,068 $4,146
42731 Atrial fibrillation $633,018 723 $7,175 $1,245 $876 $6,426 $1,492
27906 Common variabl immunodef $597,229 185 $17,223 $3,892 $3,228 $0 $11,927
72252 Lumb/lumbosac disc degen $589,197 1,056 $3,221 $451 $558 $6,575 $2,408
7802 Syncope and collapse $567,471 541 $8,749 $1,126 $1,049 $0 $7,065
4254 Prim cardiomyopathy NEC $546,012 192 $18,166 $3,641 $2,844 $2,976 $5,852
  All Other $49,332,352 73,559 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $86,234,390 88,101 - - - - -

ICD-10 Diagnosis Codes for encounters 10/01/2015 - 12/31/2015

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 $3,695,230 767 $20,523 $4,351 $4,818 $1,815 $16,002
Z5112 Encounter for antineoplastic immunotherapy $1,569,506 169 $31,139 $7,003 $9,287 $0 $20,910
G35 Multiple sclerosis $1,140,276 257 $16,212 $3,497 $4,437 $0 $6,127
Z510 Encounter for antineoplastic radiation therapy $748,478 191 $17,121 $2,719 $3,919 $0 $13,979
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $510,079 22 $112,165 $24,943 $23,185 $0 $23,760
I2511 Athscl heart disease of native coronary artery w ang pctrs $476,662 98 $36,718 $5,231 $4,864 $6,859 $24,020
R079 Chest pain, unspecified $440,141 331 $10,684 $1,468 $1,330 $573 $6,387
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $384,113 226 $13,366 $1,848 $1,700 $2,667 $5,551
G8929 Other chronic pain $366,852 600 $2,768 $439 $611 $0 $2,110
I255 Ischemic cardiomyopathy $325,654 67 $28,056 $6,038 $4,861 $0 $14,368
T8285 Stenosis of cardiac and vascular prosth dev/grft $301,341 64 $20,008 $4,083 $4,708 $0 $23,347
R0789 Other chest pain $295,444 304 $8,120 $1,053 $972 $0 $7,652
Z1211 Encounter for screening for malignant neoplasm of colon $259,460 371 $4,340 $744 $699 $0 $4,431
D839 Common variable immunodeficiency, unspecified $246,064 70 $19,102 $4,311 $3,515 $0 $11,235
C5091 Malignant neoplasm of breast of unspecified site, female $233,731 422 $2,915 $467 $554 $1,092 $4,141
T8286 Thrombosis of cardiac and vascular prosth dev/grft $229,643 47 $30,007 $6,574 $4,886 $2,803 $25,977
R55 Syncope and collapse $199,410 185 $8,636 $1,142 $1,078 $0 $7,207
Z4501 Encounter for adjustment and management of cardiac pacemaker $194,321 26 $35,918 $7,477 $7,474 $0 $8,797
N3941 Urge incontinence $186,414 15 $76,445 $18,141 $12,428 $0 $5,215
G4733 Obstructive sleep apnea (adult) (pediatric) $184,016 382 $1,856 $367 $482 $0 $2,646
  All Other $17,210,089 24,859 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $29,196,924 29,473 - - - - -

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
0229 Level II Endovascular Procedures $3,969,488 464 464 $13,706 $1,613 $8,555 $18,388
9214 Bevacizumab injection $3,779,090 467 55,836 $218 $51 $68 $270
0108 Level II ICD and Similar Procedures $3,365,482 124 124 $17,662 $2,689 $27,141 $34,730
9126 Natalizumab injection $3,220,315 672 213,600 $53 $12 $15 $51
0377 Level II Cardiac Imaging $2,639,469 2,627 2,627 $4,538 $638 $1,005 $4,240
0615 Level 4 Type A Emergency Visits $2,498,859 8,461 8,475 $1,079 $227 $295 $1,385
0634 Hospital Clinic Visits $2,396,221 22,825 27,915 $90 $51 $86 $158
9119 Injection, pegfilgrastim 6mg $2,278,482 534 647 $15,178 $3,547 $3,522 $14,512
8009 Extended Assessment & Management Composite $2,188,366 2,003 2,003 $2,351 $450 $1,093 $4,828
0207 Level III Nerve Injections $2,031,553 3,236 3,267 $1,437 $219 $622 $2,050
0083 Level I Endovascular Procedures $2,024,850 501 501 $4,462 $665 $4,042 $7,627
0849 Rituximab injection $1,993,307 287 2,807 $2,332 $545 $710 $2,649
0269 Level I Echocardiogram Without Contrast $1,912,025 5,110 5,115 $2,899 $461 $374 $2,270
1214 Inj IVIG privigen 500 mg $1,821,425 546 50,780 $208 $49 $36 $183
0440 Level V Drug Administration $1,814,028 4,150 7,195 $453 $72 $252 $827
9272 Inj, denosumab $1,796,753 1,199 122,880 $48 $11 $15 $57
0616 Level 5 Type A Emergency Visits $1,708,442 3,905 3,913 $1,520 $320 $437 $1,969
9213 Pemetrexed injection $1,510,439 234 25,598 $195 $46 $59 $233
0080 Diagnostic Cardiac Catheterization $1,505,378 660 661 $18,907 $1,617 $2,277 $13,723
1613 Trastuzumab injection $1,412,881 271 17,240 $251 $59 $82 $324
  TOTAL FOR TOP 20 $45,866,853 58,276 551,648 - - - -
  SERVICE MIX INDEX = 5.052        

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Service Statistics

Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 31,728 74,532 $32 $7 $0 4.11
IV Therapy 34,948 58,112 $318 $51 $55 0.90
Medical Surgical Supplies 35,566 73,952 $1,163 $321 $1 21.33
Laboratory 237,033 283,480 $199 $15 $3 1.66
Laboratory - Pathological 11,724 30,282 $345 $25 $7 3.52
Radiology - Diagnostic 28,007 29,263 $537 $75 $46 1.32
Radiology - Therapeutic 11,994 25,824 $794 $126 $211 3.45
Nuclear Medicine 9,130 13,584 $1,318 $186 $244 12.07
CT Scan 21,783 21,874 $2,677 $93 $179 3.56
Operating Room Services 26,430 29,122 $2,698 $411 $1,227 22.70
Anesthesia 8,858 504,856 $23 $4 $0 36.07
Blood Storage and Processing 1,504 3,001 $912 $145 $235 3.37
Other Imaging Services 7,671 7,718 $1,510 $212 $226 5.60
Respiratory Services 2,762 9,582 $314 $48 $55 1.43
Physical Therapy 6,003 8,395 $126 $30 $20 0.00
Occupational Therapy 1,889 2,662 $128 $23 $22 0.00
Speech-Language Pathology 2,073 2,211 $165 $29 $28 4.49
Emergency Room 22,008 22,060 $1,031 $217 $342 5.39
Pulmonary Function 2,572 2,994 $354 $56 $41 2.70
Cardiology 11,028 11,043 $2,347 $374 $213 5.88
Cardiac Cath Lab 1,247 1,261 $18,962 $1,621 $3,559 71.68
Ambulatory Surgical Care 16 18 $198 $30 $130 3.91
Clinic 22,920 28,067 $92 $52 $87 1.32
Magnetic Resonance Technology (MRT) 7,437 7,463 $3,683 $176 $315 5.69
Drugs Requiring Specific Identification 157,241 5,041,555 $29 $7 $7 1.76
Recovery Room 10,397 823,764 $13 $4 $0 0.00
EKG/ECG (Electrocardiogram) 16,890 20,445 $313 $23 $9 1.06
EEG (Electroencephalogram) 468 468 $868 $200 $326 6.33
Gastrointestinal Services 12 12 $2,655 $423 $334 5.02
Observation Room 4,120 132,140 $54 $9 $0 8.20
Treatment Room 2,342 2,620 $347 $196 $113 1.85
Lithotripsy 151 151 $13,136 $2,091 $2,618 41.98
Other Diagnostic Services 7,052 7,185 $1,130 $166 $188 3.17
Other Therapeutic Services 107 582 $212 $32 $45 0.71
Other Therapeutic - Cardiac Rehab 783 5,698 $167 $95 $93 1.39
Unclassified 2,508 2,619 $118 $31 $79 1.23
Audiology 0 0 $0 $0 $0 0.00
Other Therapeutic - Education / Training 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Treatments 0 0 $0 $0 $0 0.00
Labor & Delivery 0 0 $0 $0 $0 0.00
Psychiatric / Psychological Services 0 0 $0 $0 $0 0.00
Blood Products 0 0 $0 $0 $0 0.00
Oncology 0 0 $0 $0 $0 0.00
Cast Room 0 0 $0 $0 $0 0.00