• Medicare OPPS claims data are for calendar year ending 12/31/2016 (Final rule OPPS).
  • These reports are consistent with CMS cell size suppression policy.
Sample Hospital
Louisville, KY  11111
CMS Certification Number: 000000

Sample Report | Order Information

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 $15,090,104 3,061 $20,877 $3,895 $4,930 $0 $16,706
Z5112 Encounter for antineoplastic immunotherapy $10,498,475 1,066 $32,975 $6,477 $9,848 $0 $22,345
G35 Multiple sclerosis $4,151,062 1,039 $15,466 $2,906 $3,995 $0 $6,588
Z510 Encounter for antineoplastic radiation therapy $3,507,360 852 $18,159 $2,613 $4,117 $0 $14,351
R079 Chest pain, unspecified $1,543,665 1,194 $11,617 $1,482 $1,293 $6,841 $6,642
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $1,490,312 78 $96,542 $17,743 $19,107 $0 $22,692
T82858A Stenosis of vascular prosth dev/grft, init $1,433,818 323 $18,130 $3,287 $4,439 $1,732 $22,977
G8929 Other chronic pain $1,422,012 2,077 $3,288 $569 $685 $0 $2,259
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,297,907 994 $10,830 $1,421 $1,306 $11,592 $5,697
R0789 Other chest pain $1,222,530 1,186 $9,343 $1,176 $1,031 $5,907 $7,854
Z1211 Encounter for screening for malignant neoplasm of colon $1,077,756 1,446 $4,377 $769 $745 $1,414 $4,571
T82868A Thrombosis of vascular prosth dev/grft, init $1,071,593 211 $30,240 $5,647 $5,079 $5,259 $28,136
I25110 Athscl heart disease of native cor art w unstable ang pctrs $931,775 157 $45,297 $5,736 $5,935 $12,611 $35,500
D839 Common variable immunodeficiency, unspecified $894,859 279 $17,558 $3,465 $3,207 $0 $12,440
Z45010 Encntr for checking and test of card pacemaker pulse gnrtr $780,703 88 $42,899 $7,771 $8,872 $865 $23,017
R55 Syncope and collapse $749,516 694 $9,781 $1,171 $1,080 $5,609 $7,436
G4733 Obstructive sleep apnea (adult) (pediatric) $617,407 1,262 $1,912 $329 $489 $11,719 $2,688
C7951 Secondary malignant neoplasm of bone $591,276 515 $5,248 $869 $1,148 $0 $7,537
I255 Ischemic cardiomyopathy $587,027 72 $47,800 $8,596 $8,153 $0 $14,704
I480 Paroxysmal atrial fibrillation $586,661 429 $12,063 $1,894 $1,368 $1,182 $3,647
  All Other $70,934,394 100,101 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $120,480,212 117,124 - - - - -

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 $4,332,919 2,246 2,248 $1,462 $331 $1,927 $2,071
5192 Level 2 Endovascular Procedures $3,601,559 422 422 $13,866 $1,829 $8,535 $19,426
9214 Bevacizumab injection $3,190,696 369 46,080 $228 $47 $69 $284
9126 Natalizumab injection $3,111,046 590 186,300 $59 $12 $17 $58
9453 Injection, nivolumab $3,052,288 282 123,620 $80 $16 $25 $99
5232 Level 2 ICD and Similar Procedures $2,875,438 105 105 $17,537 $3,065 $27,385 $37,192
0849 Rituximab injection $2,860,722 378 3,754 $2,464 $502 $762 $2,895
9119 Injection, pegfilgrastim 6mg $2,836,965 574 733 $16,352 $3,332 $3,870 $16,286
5024 Level 4 Type A ED Visits $2,345,326 8,026 8,033 $1,079 $245 $292 $1,501
5012 Level 2 Examinations and Related Services $2,327,931 21,183 25,232 $85 $49 $92 $165
5191 Level 1 Endovascular Procedures $2,241,745 543 543 $4,288 $725 $4,128 $8,278
5593 Level 3 Nuclear Medicine and Related Services $2,161,524 2,175 2,176 $4,452 $579 $993 $4,311
5695 Level 5 Drug Administration $1,976,829 4,422 7,848 $456 $64 $252 $869
1214 Inj IVIG privigen 500 mg $1,942,146 548 53,880 $207 $42 $36 $182
9272 Inj, denosumab $1,791,214 1,211 115,260 $52 $11 $16 $61
5312 Level 2 Lower GI Procedures $1,772,145 2,517 2,756 $2,265 $396 $643 $2,723
5533 Level 3 Ultrasound and Related Services $1,750,423 4,675 4,679 $2,898 $408 $374 $2,335
5025 Level 5 Type A ED Visits $1,668,941 3,827 3,831 $1,520 $344 $436 $2,134
1613 Trastuzumab injection $1,649,824 281 18,846 $232 $47 $88 $349
5123 Level 3 Musculoskeletal Procedures $1,521,866 347 347 $5,652 $988 $4,386 $9,990
  TOTAL FOR TOP 20 $49,011,547 54,721 606,693 - - - -
  SERVICE MIX INDEX = 5.362        

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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 24,942 58,160 $43 $9 $0 0.00
IV Therapy 35,661 62,626 $312 $44 $43 0.86
Medical Surgical Supplies 35,510 73,933 $1,212 $246 $5 30.92
Laboratory 242,685 312,826 $194 $16 $2 1.19
Laboratory - Pathological 10,081 18,071 $358 $29 $4 2.53
Radiology - Diagnostic 26,644 27,758 $525 $68 $45 1.27
Radiology - Therapeutic 12,370 26,381 $822 $116 $222 3.54
Nuclear Medicine 8,947 12,587 $1,362 $177 $205 11.35
CT Scan 22,839 22,949 $2,645 $86 $153 3.30
Operating Room Services 24,749 26,476 $2,904 $508 $1,319 24.27
Anesthesia 8,796 498,420 $23 $3 $0 0.00
Blood Storage and Processing 1,685 3,025 $881 $124 $229 3.44
Other Imaging Services 8,434 8,492 $1,513 $197 $231 6.30
Respiratory Services 2,384 5,858 $242 $41 $33 1.26
Physical Therapy 6,904 9,212 $126 $30 $11 0.00
Occupational Therapy 2,559 3,372 $123 $21 $13 0.00
Speech-Language Pathology 3,019 3,224 $170 $30 $22 4.88
Emergency Room 20,949 20,986 $1,050 $238 $445 7.07
Pulmonary Function 2,827 3,201 $366 $52 $43 2.75
Cardiology 11,233 11,244 $2,367 $333 $187 5.88
Cardiac Cath Lab 1,211 1,233 $19,204 $1,801 $3,815 75.20
Clinic 21,266 25,368 $86 $49 $93 1.40
Magnetic Resonance Technology (MRT) 7,831 7,864 $3,691 $180 $290 5.41
Drugs Requiring Specific Identification 163,449 5,714,376 $30 $6 $7 73.53
Recovery Room 10,248 807,784 $13 $3 $0 0.00
EKG/ECG (Electrocardiogram) 16,925 20,645 $312 $23 $6 0.93
EEG (Electroencephalogram) 468 481 $647 $154 $303 8.41
Gastrointestinal Services 12 12 $2,506 $353 $363 5.77
Observation Room 4,443 158,487 $56 $8 $0 1.24
Treatment Room 2,731 3,136 $349 $199 $116 1.86
Lithotripsy 170 170 $13,239 $1,864 $2,594 46.03
Other Diagnostic Services 6,997 7,135 $1,102 $147 $158 3.09
Other Therapeutic Services 166 960 $215 $37 $49 0.76
Other Therapeutic - Cardiac Rehab 954 6,702 $167 $96 $93 1.41
Unclassified 3,343 3,430 $104 $28 $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