• Medicare OPPS claims data are for calendar year ending 12/31/2021 (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

ICD
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
Z5112 Encounter for antineoplastic immunotherapy $23,748,637 2,514 $46,365 $9,284 $9,447 $24,302 $38,256
Z5111 Encounter for antineoplastic chemotherapy $17,453,530 3,089 $33,534 $6,426 $5,650 $50,465 $21,887
G35 Multiple sclerosis $3,993,096 526 $36,762 $7,140 $7,591 $0 $18,521
E0500 Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis $3,989,558 72 $196,203 $40,656 $55,411 $0 $11,928
Z510 Encounter for antineoplastic radiation therapy $3,278,251 582 $24,866 $3,655 $5,633 $3,163 $14,881
M1711 Unilateral primary osteoarthritis, right knee $2,303,511 271 $70,193 $12,286 $8,500 $116,057 $18,354
M1712 Unilateral primary osteoarthritis, left knee $2,069,932 220 $76,724 $13,430 $9,409 $104,861 $18,864
M1611 Unilateral primary osteoarthritis, right hip $1,763,891 217 $78,923 $13,837 $8,129 $139,792 $21,956
G8929 Other chronic pain $1,723,523 2,114 $4,815 $796 $815 $10,876 $3,112
T82858A Stenosis of other vascular prosth dev/grft, init $1,595,502 346 $23,248 $4,350 $4,611 $4,398 $24,739
M1612 Unilateral primary osteoarthritis, left hip $1,480,638 177 $80,558 $14,148 $8,365 $113,822 $22,736
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,429,277 247 $48,723 $6,228 $5,787 $36,929 $41,910
Z1211 Encounter for screening for malignant neoplasm of colon $1,335,157 1,407 $5,754 $966 $949 $0 $6,291
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,278,723 695 $15,351 $2,018 $1,840 $17,436 $6,941
M810 Age-related osteoporosis w/o current pathological fracture $1,197,142 1,622 $4,209 $826 $738 $0 $2,247
R079 Chest pain, unspecified $1,168,865 971 $11,323 $1,321 $1,204 $10,419 $7,104
U071 COVID-19 $1,075,911 2,091 $2,180 $420 $515 $2,602 $3,473
M48062 Spinal stenosis, lumbar region with neurogenic claudication $1,011,679 220 $43,997 $7,407 $4,599 $201,960 $10,057
T82868A Thrombosis due to vascular prosth dev/grft, init $998,080 111 $46,499 $9,845 $8,992 $10,179 $33,314
I480 Paroxysmal atrial fibrillation $984,669 545 $13,348 $2,396 $1,807 $0 $6,680
  All Other $93,787,702 101,040 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $167,667,274 119,077 - - - - -

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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
5115 Level 5 Musculoskeletal Procedures $13,785,300 1,234 1,234 $13,382 $2,037 $11,171 $19,716
8011 Comprehensive Observation Services $6,547,482 3,140 3,142 $1,724 $237 $2,084 $2,906
1490 Inj pembrolizumab $4,805,035 492 128,200 $187 $39 $37 $203
5193 Level 3 Endovascular Procedures $3,659,548 401 401 $17,848 $1,992 $9,126 $25,357
5694 Level 4 Drug Administration $2,602,054 5,595 9,139 $602 $103 $285 $1,122
5012 Clinic Visits and Related Services $2,575,047 23,078 27,810 $135 $78 $93 $204
5114 Level 4 Musculoskeletal Procedures $2,558,809 451 451 $6,992 $1,064 $5,674 $12,865
5232 Level 2 ICD and Similar Procedures $2,211,739 74 74 $21,792 $3,317 $29,888 $51,043
5524 Level 4 Imaging without Contrast $2,069,016 4,692 4,694 $4,157 $591 $441 $2,935
5593 Level 3 Nuclear Medicine and Related Services $2,037,101 1,710 1,712 $5,096 $675 $1,190 $5,303
9453 Injection, nivolumab $2,001,744 216 96,020 $104 $22 $21 $117
5693 Level 3 Drug Administration $2,000,949 8,655 10,800 $488 $69 $185 $571
5623 Level 3 Radiation Therapy $2,000,558 521 4,040 $2,206 $313 $495 $4,174
5213 Level 3 Electrophysiologic Procedures $1,960,713 100 100 $38,115 $2,973 $19,607 $43,968
5192 Level 2 Endovascular Procedures $1,959,418 432 432 $13,638 $1,874 $4,536 $15,621
5572 Level 2 Imaging with Contrast $1,898,781 5,699 5,720 $4,428 $165 $332 $5,151
5594 Level 4 Nuclear Medicine and Related Services $1,845,119 1,362 1,362 $7,952 $1,054 $1,355 $7,932
5116 Level 6 Musculoskeletal Procedures $1,817,140 126 126 $5,127 $780 $14,422 $15,141
9494 Injection, ocrelizumab $1,793,445 60 33,300 $205 $43 $54 $218
9378 Daratumumab, hyaluronidase $1,774,056 123 40,500 $160 $33 $44 $186
  TOTAL FOR TOP 20 $61,903,054 58,161 369,257 - - - -
  SERVICE MIX INDEX = 6.685        

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  • Enter APC desired and statistics will appear in a new window.
  • (Only APCs representing more than 10 patients are reported.)

 

ASC
View characteristics, claims and quality data for Ambulatory Surgery Centers.
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Service Statistics

Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 26,865 121,234 $34 $7 $0 0.00
IV Therapy 31,360 56,952 $353 $50 $53 1.09
Medical Surgical Supplies 34,157 90,502 $2,363 $485 $5 67.30
Laboratory 254,595 325,088 $220 $13 $2 1.68
Laboratory - Pathological 9,597 17,621 $450 $26 $5 3.42
Radiology - Diagnostic 22,382 24,383 $515 $68 $48 1.47
Radiology - Therapeutic 14,963 31,246 $1,057 $150 $267 4.00
Nuclear Medicine 13,648 19,979 $859 $114 $121 12.14
CT Scan 43,957 48,732 $1,627 $45 $72 2.91
Operating Room Services 26,583 28,735 $4,147 $631 $1,828 31.88
Anesthesia 10,301 653,762 $27 $4 $0 0.00
Blood Storage and Processing 1,473 2,440 $1,020 $145 $237 3.54
Other Imaging Services 13,146 13,180 $1,493 $198 $231 5.62
Respiratory Services 3,002 7,028 $304 $34 $36 0.90
Physical Therapy 10,144 16,335 $214 $55 $21 0.00
Occupational Therapy 3,226 4,680 $232 $40 $26 0.00
Speech-Language Pathology 874 1,072 $529 $84 $47 0.00
Emergency Room 15,492 15,508 $1,564 $215 $657 9.25
Pulmonary Function 2,510 3,067 $421 $60 $44 2.85
Cardiology 10,831 10,846 $3,191 $453 $210 5.85
Cardiac Cath Lab 1,134 1,159 $21,517 $1,678 $5,057 94.12
Clinic 23,425 28,330 $137 $79 $92 1.45
Magnetic Resonance Technology (MRT) 14,936 15,509 $2,227 $104 $126 4.13
Drugs Requiring Specific Identification 150,331 7,171,252 $48 $10 $9 0.75
Recovery Room 10,165 841,345 $16 $4 $0 0.00
EKG/ECG (Electrocardiogram) 13,954 17,520 $344 $20 $8 0.83
EEG (Electroencephalogram) 398 405 $1,223 $191 $187 3.66
Observation Room 5,576 220,237 $69 $10 $0 0.00
Treatment Room 2,352 2,873 $347 $201 $83 2.53
Lithotripsy 142 142 $15,202 $2,160 $2,634 37.42
Psychiatric / Psychological Treatments 11 11 $845 $129 $450 5.92
Other Diagnostic Services 7,268 7,389 $1,207 $163 $157 2.93
Other Therapeutic Services 84 477 $245 $27 $51 0.68
Other Therapeutic - Cardiac Rehab 780 5,682 $193 $112 $106 1.41
Unclassified 3,479 3,601 $416 $192 $231 1.77
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
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