• Medicare OPPS claims data are for calendar year ending 12/31/2020 (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 $23,514,445 2,608 $43,564 $9,458 $9,016 $3,854 $36,780
Z5111 Encounter for antineoplastic chemotherapy $18,095,319 3,387 $30,775 $6,386 $5,343 $32,274 $21,514
Z510 Encounter for antineoplastic radiation therapy $5,443,443 895 $26,353 $4,272 $6,082 $14,821 $14,678
G35 Multiple sclerosis $4,339,461 636 $31,002 $6,516 $6,823 $0 $19,046
M1611 Unilateral primary osteoarthritis, right hip $2,178,159 231 $94,307 $17,502 $9,429 $87,869 $19,307
M1711 Unilateral primary osteoarthritis, right knee $1,978,748 218 $76,589 $14,148 $9,077 $51,650 $16,536
T82858A Stenosis of other vascular prosth dev/grft, init $1,864,932 422 $22,130 $4,439 $4,419 $5,983 $24,251
G8929 Other chronic pain $1,773,097 2,141 $4,677 $829 $828 $3,239 $3,141
M1712 Unilateral primary osteoarthritis, left knee $1,721,774 195 $74,835 $13,835 $8,830 $60,171 $16,984
M1612 Unilateral primary osteoarthritis, left hip $1,718,099 179 $96,445 $17,932 $9,598 $68,463 $20,108
T82868A Thrombosis due to vascular prosth dev/grft, init $1,548,006 189 $38,222 $8,339 $8,191 $1,332 $32,065
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,362,911 194 $57,236 $8,257 $7,025 $19,872 $41,096
Z1211 Encounter for screening for malignant neoplasm of colon $1,309,723 1,386 $5,836 $1,058 $945 $0 $6,000
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,201,775 722 $13,254 $1,894 $1,665 $12,226 $6,708
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $1,179,208 50 $139,079 $24,640 $23,584 $0 $17,693
R079 Chest pain, unspecified $1,089,130 855 $11,967 $1,505 $1,274 $9,909 $7,240
J4550 Severe persistent asthma, uncomplicated $1,029,929 253 $15,723 $3,505 $4,071 $0 $10,459
C61 Malignant neoplasm of prostate $970,525 1,167 $8,156 $1,254 $832 $32,942 $5,916
I480 Paroxysmal atrial fibrillation $914,667 516 $14,031 $2,704 $1,773 $0 $5,596
E0500 Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis $849,428 19 $162,899 $36,320 $44,707 $0 $8,181
  All Other $83,778,444 97,781 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $157,861,223 114,044 - - - - -

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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
5115 Level 5 Musculoskeletal Procedures $10,135,128 930 930 $12,568 $2,075 $10,898 $18,089
1490 Inj pembrolizumab $8,486,180 881 230,263 $182 $41 $37 $199
8011 Comprehensive Observation Services $6,313,853 3,122 3,122 $1,720 $248 $2,022 $2,689
9453 Injection, nivolumab $4,128,331 437 196,640 $102 $23 $21 $115
5193 Level 3 Endovascular Procedures $4,037,333 443 443 $16,968 $2,191 $9,114 $24,234
9494 Injection, ocrelizumab $3,059,021 108 58,200 $204 $46 $53 $215
5694 Level 4 Drug Administration $2,846,637 5,801 9,962 $604 $103 $286 $1,072
5012 Clinic Visits and Related Services $2,607,022 23,195 28,182 $136 $85 $93 $195
5114 Level 4 Musculoskeletal Procedures $2,422,769 449 449 $6,847 $1,130 $5,396 $12,143
5192 Level 2 Endovascular Procedures $2,271,843 498 498 $13,132 $2,010 $4,562 $14,834
5623 Level 3 Radiation Therapy $2,142,996 575 4,287 $2,221 $346 $500 $3,924
9272 Inj, denosumab $2,121,833 1,733 147,902 $75 $17 $14 $81
5232 Level 2 ICD and Similar Procedures $2,095,082 71 71 $19,954 $3,294 $29,508 $48,281
9476 Injection, daratumumab 10 mg $2,060,969 264 51,677 $203 $46 $40 $228
5194 Level 4 Endovascular Procedures $1,969,352 135 135 $21,483 $2,710 $14,588 $29,104
5594 Level 4 Nuclear Medicine and Related Services $1,948,904 1,465 1,465 $7,946 $1,082 $1,330 $7,634
5572 Level 2 Imaging with Contrast $1,879,659 5,350 5,366 $4,433 $176 $350 $4,992
5524 Level 4 Imaging without Contrast $1,862,967 4,211 4,214 $4,176 $650 $442 $2,770
5213 Level 3 Electrophysiologic Procedures $1,861,873 101 101 $38,115 $3,141 $18,434 $41,538
5693 Level 3 Drug Administration $1,820,817 8,293 10,819 $488 $76 $168 $534
  TOTAL FOR TOP 20 $66,072,569 58,062 754,726 - - - -
  SERVICE MIX INDEX = 6.388        

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  • (Only APCs representing more than 10 patients are reported.)

 

ASC
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Service Statistics
Service Number Patient Claims Units of Service Average Charge Average Cost Average Payment Service Mix Index - SMI
Pharmacy 20,757 48,657 $62 $14 $0 0.00
IV Therapy 33,541 62,913 $350 $54 $45 0.99
Medical Surgical Supplies 33,080 79,186 $2,140 $475 $7 79.76
Laboratory 262,171 332,691 $219 $15 $2 1.62
Laboratory - Pathological 7,572 13,905 $470 $31 $5 3.41
Radiology - Diagnostic 21,117 22,367 $545 $74 $52 1.65
Radiology - Therapeutic 16,491 34,864 $1,051 $164 $273 4.08
Nuclear Medicine 12,709 18,992 $836 $114 $113 11.90
CT Scan 40,495 44,346 $1,703 $47 $80 3.09
Operating Room Services 25,450 28,164 $4,072 $672 $1,706 29.35
Anesthesia 9,679 578,967 $27 $4 $0 0.00
Blood Storage and Processing 1,464 2,599 $1,075 $167 $259 3.71
Other Imaging Services 12,033 12,078 $1,659 $226 $253 6.00
Respiratory Services 3,563 6,751 $326 $35 $41 1.24
Physical Therapy 7,764 11,910 $218 $56 $20 0.00
Occupational Therapy 2,110 3,156 $230 $42 $28 0.00
Speech-Language Pathology 793 976 $527 $90 $46 0.00
Emergency Room 15,903 15,913 $1,553 $224 $626 8.94
Pulmonary Function 2,545 3,145 $387 $60 $38 2.62
Cardiology 9,966 9,975 $3,140 $489 $207 5.98
Cardiac Cath Lab 1,060 1,094 $22,065 $1,818 $5,010 94.17
Clinic 23,507 28,616 $137 $85 $92 1.44
Magnetic Resonance Technology (MRT) 13,041 13,465 $2,353 $122 $142 4.32
Drugs Requiring Specific Identification 165,362 7,079,058 $46 $10 $8 3.24
Recovery Room 9,627 793,016 $16 $4 $0 0.00
EKG/ECG (Electrocardiogram) 14,023 17,474 $344 $20 $7 0.86
EEG (Electroencephalogram) 393 395 $1,278 $227 $173 3.60
Observation Room 5,468 197,119 $67 $10 $0 25.17
Treatment Room 2,582 3,160 $327 $204 $80 2.32
Lithotripsy 118 118 $15,202 $2,365 $2,474 37.36
Other Diagnostic Services 6,969 7,106 $1,212 $172 $161 3.04
Other Therapeutic Services 88 532 $245 $26 $51 0.68
Other Therapeutic - Cardiac Rehab 795 5,426 $193 $120 $102 1.36
Unclassified 1,710 1,783 $212 $51 $32 0.73
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
Psychiatric / Psychological Treatments 0 0 $0 $0 $0 0.00