• Medicare OPPS claims data are for calendar year ending 12/31/2016 (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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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 $13,657,744 2,808 $20,784 $4,394 $4,864 $0 $16,399
Z5112 Encounter for antineoplastic immunotherapy $9,098,287 946 $32,099 $7,180 $9,618 $0 $22,136
G35 Multiple sclerosis $3,563,329 944 $14,772 $3,155 $3,775 $0 $6,449
Z510 Encounter for antineoplastic radiation therapy $3,205,314 775 $18,188 $2,946 $4,136 $0 $14,055
R079 Chest pain, unspecified $1,455,466 1,128 $11,577 $1,576 $1,290 $6,057 $6,586
T82858A Stenosis of vascular prosth dev/grft, init $1,380,128 309 $18,179 $3,710 $4,466 $1,732 $23,020
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $1,367,162 71 $98,033 $21,829 $19,256 $0 $22,635
G8929 Other chronic pain $1,328,219 1,940 $3,266 $578 $685 $0 $2,124
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,258,948 946 $11,020 $1,580 $1,331 $10,731 $5,668
R0789 Other chest pain $1,156,992 1,123 $9,335 $1,227 $1,030 $5,907 $7,792
Z1211 Encounter for screening for malignant neoplasm of colon $1,043,830 1,399 $4,385 $758 $746 $1,414 $4,578
T82868A Thrombosis of vascular prosth dev/grft, init $932,244 189 $29,854 $6,485 $4,933 $5,259 $27,423
I25110 Athscl heart disease of native cor art w unstable ang pctrs $851,471 140 $45,369 $6,456 $6,082 $11,510 $35,393
D839 Common variable immunodeficiency, unspecified $833,026 263 $17,433 $3,931 $3,167 $0 $12,351
Z45010 Encntr for checking and test of card pacemaker pulse gnrtr $772,280 87 $42,946 $8,973 $8,877 $865 $22,894
R55 Syncope and collapse $712,922 657 $9,729 $1,264 $1,085 $4,487 $7,326
G4733 Obstructive sleep apnea (adult) (pediatric) $591,624 1,198 $1,948 $391 $494 $11,719 $2,674
I255 Ischemic cardiomyopathy $585,590 70 $48,970 $10,545 $8,366 $0 $14,012
I480 Paroxysmal atrial fibrillation $548,010 407 $11,773 $2,304 $1,346 $1,161 $3,580
C7951 Secondary malignant neoplasm of bone $524,807 464 $5,160 $953 $1,131 $0 $7,416
  All Other $65,249,786 92,744 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $110,117,179 108,608 - - - - -

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 $3,962,409 2,053 2,055 $1,462 $308 $1,928 $2,073
5192 Level 2 Endovascular Procedures $3,324,218 390 390 $14,046 $1,648 $8,524 $19,553
9214 Bevacizumab injection $2,874,560 335 41,630 $228 $53 $69 $285
9126 Natalizumab injection $2,850,219 543 171,300 $59 $14 $17 $58
9453 Injection, nivolumab $2,728,960 249 109,760 $79 $19 $25 $100
5232 Level 2 ICD and Similar Procedures $2,626,714 96 96 $17,936 $2,733 $27,362 $38,020
0849 Rituximab injection $2,591,017 347 3,399 $2,459 $575 $762 $2,898
9119 Injection, pegfilgrastim 6mg $2,459,158 505 637 $16,292 $3,807 $3,861 $16,226
5024 Level 4 Type A ED Visits $2,202,754 7,521 7,526 $1,079 $227 $293 $1,498
5191 Level 1 Endovascular Procedures $2,135,271 517 517 $4,236 $629 $4,130 $8,254
5593 Level 3 Nuclear Medicine and Related Services $2,081,930 2,093 2,094 $4,454 $626 $994 $4,310
5012 Level 2 Examinations and Related Services $2,003,363 18,575 21,713 $83 $47 $92 $165
1214 Inj IVIG privigen 500 mg $1,799,591 507 49,960 $208 $49 $36 $181
5695 Level 5 Drug Administration $1,791,338 3,987 7,106 $457 $73 $252 $866
5312 Level 2 Lower GI Procedures $1,706,976 2,423 2,651 $2,267 $345 $644 $2,724
5533 Level 3 Ultrasound and Related Services $1,664,581 4,440 4,444 $2,898 $461 $375 $2,332
9272 Inj, denosumab $1,643,858 1,113 105,780 $52 $12 $16 $61
5025 Level 5 Type A ED Visits $1,550,927 3,552 3,555 $1,520 $320 $436 $2,124
1613 Trastuzumab injection $1,455,360 248 16,671 $239 $56 $87 $349
5123 Level 3 Musculoskeletal Procedures $1,443,218 328 328 $5,631 $858 $4,400 $9,709
  TOTAL FOR TOP 20 $44,896,422 49,822 551,612 - - - -
  SERVICE MIX INDEX = 5.463        

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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 23,353 54,998 $42 $10 $0 0.00
IV Therapy 32,703 57,209 $313 $50 $43 0.87
Medical Surgical Supplies 33,246 68,732 $1,204 $336 $5 28.98
Laboratory 223,962 276,826 $201 $15 $3 1.19
Laboratory - Pathological 9,171 16,503 $353 $25 $4 2.46
Radiology - Diagnostic 24,851 25,787 $528 $74 $45 1.28
Radiology - Therapeutic 11,138 23,650 $828 $132 $224 3.52
Nuclear Medicine 8,496 12,023 $1,360 $191 $207 11.40
CT Scan 21,358 21,459 $2,646 $92 $155 3.30
Operating Room Services 22,656 23,461 $3,051 $465 $1,384 25.67
Anesthesia 8,359 470,221 $23 $4 $0 0.00
Blood Storage and Processing 1,524 2,746 $882 $140 $229 3.44
Other Imaging Services 7,990 8,044 $1,494 $210 $229 6.24
Respiratory Services 2,184 4,595 $194 $29 $20 1.14
Physical Therapy 6,113 8,148 $125 $30 $11 0.00
Occupational Therapy 2,206 2,934 $123 $22 $13 0.00
Speech-Language Pathology 2,577 2,767 $169 $30 $23 4.84
Emergency Room 19,566 19,597 $1,047 $220 $442 7.02
Pulmonary Function 2,646 2,948 $372 $59 $43 2.77
Cardiology 10,655 10,666 $2,366 $377 $188 5.90
Cardiac Cath Lab 1,131 1,151 $19,182 $1,640 $3,815 74.84
Clinic 18,632 21,807 $84 $48 $93 1.40
Magnetic Resonance Technology (MRT) 7,393 7,425 $3,691 $176 $292 5.41
Drugs Requiring Specific Identification 151,461 5,259,488 $29 $7 $7 90.96
Recovery Room 9,721 764,106 $13 $4 $0 0.00
EKG/ECG (Electrocardiogram) 15,816 19,242 $313 $22 $6 0.93
EEG (Electroencephalogram) 430 442 $652 $151 $311 8.44
Gastrointestinal Services 11 11 $2,488 $396 $364 5.81
Observation Room 4,098 145,880 $55 $9 $0 1.24
Treatment Room 2,404 2,729 $353 $200 $117 1.85
Lithotripsy 161 161 $13,244 $2,108 $2,636 46.03
Other Diagnostic Services 6,639 6,766 $1,101 $161 $158 3.07
Other Therapeutic Services 163 942 $215 $33 $50 0.76
Other Therapeutic - Cardiac Rehab 846 5,986 $167 $95 $93 1.41
Unclassified 3,056 3,130 $101 $29 $39 0.65
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