• Medicare OPPS claims data are for calendar year ending 12/31/2018 (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 $15,038,223 3,267 $23,529 $4,583 $4,603 $12,592 $19,228
Z5112 Encounter for antineoplastic immunotherapy $13,807,746 1,612 $34,386 $7,044 $8,566 $4,956 $30,188
G35 Multiple sclerosis $4,811,192 842 $23,604 $4,662 $5,714 $0 $13,199
Z510 Encounter for antineoplastic radiation therapy $2,533,578 514 $21,590 $3,367 $4,929 $0 $14,117
T82868A Thrombosis due to vascular prosth dev/grft, init $2,150,865 254 $38,310 $8,433 $8,468 $11,105 $29,134
T82858A Stenosis of other vascular prosth dev/grft, init $2,039,463 431 $22,594 $4,612 $4,732 $9,324 $22,351
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,750,557 308 $49,087 $6,640 $5,684 $56,572 $37,466
G8929 Other chronic pain $1,573,089 2,519 $4,106 $742 $624 $0 $2,579
Z1211 Encounter for screening for malignant neoplasm of colon $1,343,572 1,640 $4,881 $892 $819 $0 $5,200
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,332,755 1,218 $9,112 $1,368 $1,094 $11,791 $6,133
R079 Chest pain, unspecified $1,236,162 970 $11,842 $1,541 $1,274 $15,602 $7,095
C61 Malignant neoplasm of prostate $1,215,941 1,239 $6,258 $899 $981 $11,847 $4,967
R0789 Other chest pain $1,105,182 945 $11,214 $1,393 $1,170 $18,911 $8,470
R55 Syncope and collapse $763,412 656 $10,969 $1,277 $1,164 $9,627 $7,935
I480 Paroxysmal atrial fibrillation $758,375 675 $9,890 $1,837 $1,124 $4,279 $4,476
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $747,161 39 $118,741 $22,067 $19,158 $2,776 $18,131
C220 Liver cell carcinoma $707,200 215 $22,813 $3,985 $3,289 $34,351 $11,062
D839 Common variable immunodeficiency, unspecified $664,821 255 $18,514 $3,803 $2,607 $0 $13,956
D593 Hemolytic-uremic syndrome $656,749 25 $111,705 $23,356 $26,270 $0 $83,339
G4733 Obstructive sleep apnea (adult) (pediatric) $617,059 1,435 $1,635 $295 $430 $0 $2,584
  All Other $76,968,149 102,133 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $131,821,251 121,192 - - - - -

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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 $5,154,475 2,462 2,464 $1,709 $367 $2,092 $2,415
5193 Level 3 Endovascular Procedures $4,692,454 502 503 $17,598 $2,342 $9,329 $19,206
1490 Inj pembrolizumab $3,497,875 395 100,094 $149 $32 $35 $185
9453 Injection, nivolumab $3,222,814 407 165,099 $84 $18 $20 $106
9494 Injection, ocrelizumab $2,961,199 110 54,913 $189 $40 $54 $204
5012 Clinic Visits and Related Services $2,909,204 23,485 28,337 $136 $73 $103 $182
0849 Rituximab injection $2,768,018 322 3,200 $2,844 $604 $865 $3,460
5192 Level 2 Endovascular Procedures $2,484,953 545 545 $12,583 $2,028 $4,560 $13,606
5694 Level 4 Drug Administration $2,319,505 5,046 8,639 $574 $94 $268 $966
5115 Level 5 Musculoskeletal Procedures $2,267,645 249 249 $9,588 $1,639 $9,107 $14,341
5693 Level 3 Drug Administration $2,193,928 9,694 12,802 $459 $69 $171 $462
5593 Level 3 Nuclear Medicine and Related Services $2,176,185 2,011 2,011 $4,853 $667 $1,082 $4,723
5232 Level 2 ICD and Similar Procedures $2,155,386 77 77 $19,529 $3,337 $27,992 $42,772
5524 Level 4 Imaging without Contrast $2,138,127 4,890 4,894 $4,325 $652 $437 $2,556
5114 Level 4 Musculoskeletal Procedures $2,119,272 423 423 $6,753 $1,154 $5,010 $10,793
9119 Injection, pegfilgrastim 6mg $2,113,941 523 642 $19,395 $4,118 $3,293 $20,114
5024 Level 4 Type A ED Visits $2,061,700 6,482 6,487 $1,600 $344 $318 $1,730
9214 Bevacizumab injection $2,042,584 341 36,170 $252 $54 $56 $321
1613 Trastuzumab injection $1,793,468 286 17,991 $325 $69 $100 $408
5594 Level 4 Nuclear Medicine and Related Services $1,755,709 1,414 1,414 $7,551 $1,037 $1,242 $6,638
  TOTAL FOR TOP 20 $52,828,442 59,664 446,954 - - - -
  SERVICE MIX INDEX = 5.635        

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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 22,399 48,679 $52 $11 $0 0.00
IV Therapy 34,601 63,486 $340 $51 $51 1.08
Medical Surgical Supplies 36,639 82,646 $1,280 $309 $6 48.84
Oncology 13 15 $691 $104 $49 2.60
Laboratory 262,467 328,513 $205 $13 $2 1.72
Laboratory - Pathological 9,049 15,457 $479 $30 $5 2.91
Radiology - Diagnostic 24,335 25,493 $532 $73 $46 1.37
Radiology - Therapeutic 13,174 26,831 $897 $135 $229 3.53
Nuclear Medicine 9,114 14,843 $1,285 $177 $200 11.68
CT Scan 24,441 24,545 $2,915 $82 $143 3.07
Operating Room Services 26,245 29,224 $3,424 $585 $1,331 22.90
Anesthesia 10,363 533,633 $26 $4 $0 0.00
Blood Storage and Processing 1,398 2,703 $1,002 $151 $242 3.43
Other Imaging Services 9,704 9,740 $1,725 $237 $232 5.93
Respiratory Services 4,036 8,189 $275 $39 $33 1.16
Physical Therapy 8,126 10,645 $136 $32 $11 0.00
Occupational Therapy 2,187 2,755 $135 $25 $13 0.00
Speech-Language Pathology 2,459 2,646 $174 $32 $17 4.77
Emergency Room 18,194 18,215 $1,544 $332 $527 7.89
Pulmonary Function 2,447 2,875 $390 $59 $40 2.71
Cardiology 10,857 10,865 $3,253 $490 $217 6.20
Cardiac Cath Lab 1,221 1,245 $20,916 $1,849 $4,271 81.00
Clinic 23,586 28,499 $137 $73 $103 1.45
Magnetic Resonance Technology (MRT) 8,003 8,052 $4,050 $191 $274 4.84
Drugs Requiring Specific Identification 169,543 6,450,484 $34 $7 $7 0.74
Recovery Room 10,147 745,611 $15 $4 $0 0.00
EKG/ECG (Electrocardiogram) 15,893 19,414 $348 $24 $7 0.93
EEG (Electroencephalogram) 458 486 $1,372 $290 $217 4.81
Observation Room 4,562 152,784 $65 $10 $0 0.00
Treatment Room 3,032 3,733 $290 $155 $73 2.17
Lithotripsy 162 162 $14,478 $2,183 $3,038 47.13
Other Diagnostic Services 7,988 8,212 $1,189 $169 $172 3.33
Other Therapeutic Services 90 509 $233 $33 $49 0.71
Other Therapeutic - Cardiac Rehab 876 6,020 $184 $98 $105 1.48
Unclassified 2,813 2,907 $133 $33 $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