• Medicare OPPS claims data are for calendar year ending 12/31/2019 (Final 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

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ICD
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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 $19,408,959 2,277 $36,904 $7,360 $8,524 $16,045 $33,488
Z5111 Encounter for antineoplastic chemotherapy $18,213,112 3,488 $26,483 $4,996 $5,222 $22,095 $20,672
G35 Multiple sclerosis $4,705,951 735 $24,972 $4,817 $6,403 $0 $15,793
Z510 Encounter for antineoplastic radiation therapy $4,657,523 902 $22,984 $3,378 $5,164 $913 $14,086
T82868A Thrombosis due to vascular prosth dev/grft, init $1,878,481 240 $39,611 $8,234 $7,827 $31,234 $30,762
G8929 Other chronic pain $1,864,206 2,628 $4,388 $712 $709 $6,673 $2,799
T82858A Stenosis of other vascular prosth dev/grft, init $1,862,370 421 $22,745 $4,197 $4,424 $11,078 $22,943
Z1211 Encounter for screening for malignant neoplasm of colon $1,603,233 1,804 $5,091 $864 $889 $0 $5,573
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,450,420 265 $46,613 $5,790 $5,473 $13,587 $38,529
M1711 Unilateral primary osteoarthritis, right knee $1,398,384 197 $62,303 $10,714 $7,098 $47,147 $12,120
R0789 Other chest pain $1,383,556 1,022 $12,833 $1,444 $1,354 $14,879 $9,023
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,316,151 1,002 $10,760 $1,455 $1,314 $13,369 $6,575
M1712 Unilateral primary osteoarthritis, left knee $1,265,210 194 $57,131 $9,773 $6,522 $42,233 $12,582
R079 Chest pain, unspecified $1,204,149 954 $11,539 $1,365 $1,262 $4,183 $7,272
C61 Malignant neoplasm of prostate $1,202,240 1,359 $5,934 $815 $885 $18,439 $5,408
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $955,125 50 $109,495 $18,253 $19,102 $0 $16,750
I480 Paroxysmal atrial fibrillation $915,283 636 $11,983 $2,132 $1,439 $0 $5,104
R55 Syncope and collapse $890,369 655 $12,143 $1,280 $1,359 $3,006 $8,337
J4550 Severe persistent asthma, uncomplicated $873,100 234 $13,171 $2,694 $3,731 $0 $9,444
G4733 Obstructive sleep apnea (adult) (pediatric) $812,262 1,449 $2,499 $435 $561 $0 $2,536
  All Other $87,404,848 112,679 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $155,264,932 133,191 - - - - -

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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 $7,666,772 3,562 3,563 $1,697 $234 $2,152 $2,570
1490 Inj pembrolizumab $6,420,517 705 180,490 $154 $32 $36 $192
5115 Level 5 Musculoskeletal Procedures $4,717,204 494 494 $10,371 $1,578 $9,549 $14,706
5193 Level 3 Endovascular Procedures $4,420,482 505 505 $17,259 $2,079 $8,753 $23,227
9453 Injection, nivolumab $4,008,811 456 200,681 $86 $18 $20 $110
5012 Clinic Visits and Related Services $3,476,188 27,069 33,070 $136 $79 $105 $189
9494 Injection, ocrelizumab $3,140,768 102 57,300 $176 $37 $55 $212
5114 Level 4 Musculoskeletal Procedures $2,717,021 533 533 $6,517 $992 $5,098 $11,414
9214 Bevacizumab injection $2,492,372 374 42,457 $259 $54 $59 $335
5694 Level 4 Drug Administration $2,489,048 5,721 9,513 $572 $89 $262 $983
9186 Inj., rituximab, 10 mg $2,431,025 352 35,644 $306 $63 $68 $382
5192 Level 2 Endovascular Procedures $2,253,354 531 531 $12,436 $1,807 $4,244 $14,226
5572 Level 2 Imaging with Contrast $2,252,642 6,467 6,483 $4,214 $155 $347 $4,854
5623 Level 3 Radiation Therapy $2,211,104 620 4,678 $2,128 $302 $473 $3,734
5024 Level 4 Type A ED Visits $2,193,191 6,757 6,759 $1,600 $220 $324 $1,859
5693 Level 3 Drug Administration $2,149,325 9,587 12,743 $460 $65 $169 $499
5594 Level 4 Nuclear Medicine and Related Services $2,119,466 1,699 1,699 $7,554 $1,001 $1,247 $7,346
5524 Level 4 Imaging without Contrast $2,110,757 4,697 4,702 $4,316 $613 $449 $2,670
5593 Level 3 Nuclear Medicine and Related Services $2,043,893 1,846 1,846 $4,875 $646 $1,107 $4,961
9272 Inj, denosumab $1,947,560 1,673 142,201 $63 $13 $14 $76
  TOTAL FOR TOP 20 $63,261,500 73,750 745,892 - - - -
  SERVICE MIX INDEX = 5.855        

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Service Statistics
Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 23,911 55,663 $51 $11 $0 0.00
IV Therapy 37,835 73,145 $330 $47 $45 1.01
Medical Surgical Supplies 36,392 80,434 $1,672 $370 $4 34.01
Laboratory 295,768 368,674 $206 $12 $2 1.86
Laboratory - Pathological 8,409 15,315 $462 $27 $5 3.41
Radiology - Diagnostic 26,326 27,663 $517 $69 $44 1.48
Radiology - Therapeutic 16,212 35,740 $986 $140 $240 3.84
Nuclear Medicine 10,544 15,610 $1,163 $154 $158 11.63
CT Scan 27,882 27,992 $2,914 $81 $147 3.06
Operating Room Services 28,710 31,490 $3,614 $550 $1,447 26.35
Anesthesia 11,448 629,860 $26 $4 $0 0.00
Blood Storage and Processing 1,560 2,756 $996 $141 $249 3.51
Other Imaging Services 11,547 11,587 $1,690 $224 $240 5.74
Respiratory Services 5,378 10,827 $273 $30 $32 1.04
Physical Therapy 6,774 10,128 $207 $53 $19 11.25
Occupational Therapy 1,813 2,685 $214 $37 $26 0.00
Speech-Language Pathology 860 970 $496 $79 $40 0.00
Emergency Room 19,931 19,950 $1,542 $212 $615 8.42
Pulmonary Function 3,078 3,630 $385 $55 $40 2.68
Cardiology 11,531 11,541 $3,172 $451 $206 6.08
Cardiac Cath Lab 1,251 1,263 $21,113 $1,647 $4,497 82.88
Ambulatory Surgical Care 11 11 $777 $118 $1,040 15.51
Clinic 27,278 33,387 $137 $79 $105 1.45
Magnetic Resonance Technology (MRT) 9,074 9,145 $4,029 $189 $248 4.33
Drugs Requiring Specific Identification 183,200 7,437,474 $36 $7 $7 0.00
Recovery Room 11,197 827,843 $15 $3 $0 0.00
EKG/ECG (Electrocardiogram) 17,605 21,958 $341 $19 $7 0.89
EEG (Electroencephalogram) 485 510 $1,412 $221 $185 4.64
Observation Room 6,085 212,450 $66 $9 $0 20.26
Treatment Room 3,181 3,828 $247 $143 $59 1.68
Lithotripsy 150 150 $14,478 $2,057 $2,387 37.36
Psychiatric / Psychological Treatments 13 13 $805 $123 $415 6.01
Other Diagnostic Services 8,648 8,863 $1,186 $161 $169 3.25
Other Therapeutic Services 169 1,044 $233 $26 $51 0.68
Other Therapeutic - Cardiac Rehab 1,020 7,447 $184 $107 $107 1.36
Unclassified 1,848 1,938 $210 $44 $26 0.68
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