• Medicare OPPS claims data are for calendar year ending 12/31/2017 (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 $15,029,371 3,027 $21,072 $4,104 $4,965 $29,176 $17,940
Z5112 Encounter for antineoplastic immunotherapy $13,120,593 1,430 $31,052 $6,337 $9,175 $0 $24,941
G35 Multiple sclerosis $5,083,326 980 $19,831 $3,932 $5,187 $12,864 $9,217
Z510 Encounter for antineoplastic radiation therapy $3,076,751 713 $18,795 $2,872 $4,315 $0 $14,421
T82858A Stenosis of other vascular prosth dev/grft, init $1,974,473 443 $20,104 $4,113 $4,457 $5,695 $21,252
T82868A Thrombosis due to vascular prosth dev/grft, init $1,904,882 223 $33,651 $7,188 $8,542 $9,478 $28,346
R079 Chest pain, unspecified $1,530,650 1,143 $11,572 $1,492 $1,339 $26,053 $6,915
G8929 Other chronic pain $1,382,108 2,096 $4,015 $728 $659 $0 $2,258
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,276,053 1,069 $9,321 $1,319 $1,194 $10,259 $5,878
C61 Malignant neoplasm of prostate $1,254,253 1,209 $5,579 $860 $1,037 $0 $4,233
Z1211 Encounter for screening for malignant neoplasm of colon $1,159,354 1,505 $4,439 $787 $770 $0 $4,864
R0789 Other chest pain $1,135,468 1,119 $8,887 $1,115 $1,015 $12,300 $8,127
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,080,016 168 $47,081 $6,569 $6,429 $16,926 $36,729
D839 Common variable immunodeficiency, unspecified $910,061 285 $17,744 $3,654 $3,193 $0 $13,179
I480 Paroxysmal atrial fibrillation $855,257 577 $12,028 $2,278 $1,482 $2,759 $3,925
R55 Syncope and collapse $831,403 729 $9,606 $1,109 $1,140 $4,649 $7,691
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $797,194 43 $98,689 $18,332 $18,539 $0 $20,127
Z45010 Encntr for checking and test of card pacemaker pulse gnrtr $729,314 77 $47,061 $8,722 $9,472 $0 $21,387
I255 Ischemic cardiomyopathy $667,693 86 $45,324 $8,309 $7,764 $0 $13,535
G4733 Obstructive sleep apnea (adult) (pediatric) $640,536 1,498 $1,465 $254 $428 $12,583 $2,639
  All Other $80,336,647 105,657 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $134,775,403 124,077 - - - - -

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 $5,416,269 2,701 2,701 $1,478 $318 $2,005 $2,217
5193 Level 3 Endovascular Procedures $4,661,504 527 527 $16,003 $2,184 $8,845 $21,047
5012 Clinic Visits and Related Services $2,842,910 23,980 29,239 $87 $51 $97 $174
5192 Level 2 Endovascular Procedures $2,267,869 519 519 $10,987 $1,869 $4,370 $12,389
5693 Level 3 Drug Administration $2,248,150 10,642 13,803 $413 $62 $163 $432
5694 Level 4 Drug Administration $2,208,599 4,946 8,709 $484 $83 $254 $916
5024 Level 4 Type A ED Visits $2,207,255 7,350 7,357 $1,079 $232 $300 $1,614
5524 Level 4 Imaging without Contrast $2,133,292 5,244 5,250 $2,850 $434 $406 $2,438
5593 Level 3 Nuclear Medicine and Related Services $2,087,232 2,025 2,025 $4,424 $608 $1,031 $4,503
5232 Level 2 ICD and Similar Procedures $2,063,425 74 74 $17,683 $3,022 $27,884 $40,101
5114 Level 4 Musculoskeletal Procedures $1,969,525 419 419 $6,001 $1,026 $4,701 $10,249
5194 Level 4 Endovascular Procedures $1,897,617 143 143 $20,288 $2,961 $13,270 $24,559
5594 Level 4 Nuclear Medicine and Related Services $1,636,004 1,363 1,363 $6,862 $943 $1,200 $6,987
5463 Level 3 Neurostimulator and Related Procedures $1,516,013 95 95 $2,893 $494 $15,958 $8,746
5025 Level 5 Type A ED Visits $1,482,726 3,347 3,350 $1,520 $327 $443 $2,258
5523 Level 3 Imaging without Contrast $1,451,184 6,932 7,082 $2,514 $150 $205 $2,629
5213 Level 3 Electrophysiologic Procedures $1,445,731 97 97 $33,000 $2,917 $14,904 $34,801
5191 Level 1 Endovascular Procedures $1,405,191 550 550 $18,620 $1,646 $2,555 $14,879
5572 Level 2 Imaging with Contrast $1,394,882 3,611 3,618 $4,008 $170 $386 $4,502
5182 Level 2 Vascular Procedures $1,371,622 634 664 $4,068 $681 $2,066 $6,849
  TOTAL FOR TOP 20 $43,707,000 75,199 87,585 - - - -
  SERVICE MIX INDEX = 5.528        

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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 25,400 83,322 $33 $7 $0 0.00
IV Therapy 35,992 63,963 $310 $47 $54 1.08
Medical Surgical Supplies 37,716 81,043 $1,228 $296 $11 58.64
Laboratory 265,965 347,206 $187 $12 $2 1.27
Laboratory - Pathological 12,110 31,508 $288 $18 $2 2.44
Radiology - Diagnostic 26,207 27,478 $500 $69 $46 1.39
Radiology - Therapeutic 13,168 28,477 $818 $123 $220 3.42
Nuclear Medicine 9,520 13,510 $1,237 $170 $187 11.32
CT Scan 24,881 25,004 $2,654 $74 $148 3.26
Operating Room Services 27,076 30,346 $2,988 $511 $1,277 23.16
Anesthesia 10,045 532,833 $23 $4 $0 0.00
Blood Storage and Processing 1,835 3,685 $908 $137 $243 3.60
Other Imaging Services 9,084 9,134 $1,589 $218 $231 5.95
Respiratory Services 4,050 11,643 $274 $39 $38 1.29
Physical Therapy 7,992 10,500 $125 $29 $11 0.00
Occupational Therapy 2,452 3,152 $120 $22 $12 0.00
Speech-Language Pathology 2,609 2,774 $165 $30 $19 4.71
Emergency Room 19,994 20,025 $1,062 $228 $504 7.83
Pulmonary Function 2,826 3,138 $374 $56 $39 2.82
Cardiology 11,170 11,177 $2,375 $358 $195 6.07
Cardiac Cath Lab 1,172 1,194 $19,194 $1,697 $4,319 85.98
Ambulatory Surgical Care 18 20 $361 $62 $469 19.64
Clinic 24,128 29,476 $88 $52 $97 1.43
Magnetic Resonance Technology (MRT) 8,575 8,634 $3,691 $174 $265 4.96
Drugs Requiring Specific Identification 174,008 6,097,764 $32 $7 $8 0.00
Recovery Room 10,570 820,744 $13 $4 $0 0.00
EKG/ECG (Electrocardiogram) 17,019 20,764 $316 $22 $6 0.96
EEG (Electroencephalogram) 451 474 $685 $145 $324 7.78
Gastrointestinal Services 22 22 $2,706 $408 $350 5.54
Observation Room 4,786 162,006 $57 $9 $0 0.00
Treatment Room 3,376 4,211 $352 $206 $97 2.93
Lithotripsy 165 166 $13,162 $1,986 $2,869 46.45
Other Diagnostic Services 7,700 7,881 $1,115 $158 $178 3.53
Other Therapeutic Services 178 1,039 $212 $30 $49 0.73
Other Therapeutic - Cardiac Rehab 854 5,903 $167 $98 $101 1.47
Unclassified 2,761 2,848 $161 $38 $40 0.65
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