• Medicare OPPS claims data are for calendar year ending 12/31/2019 (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 $17,350,604 2,033 $36,958 $7,381 $8,534 $16,045 $33,333
Z5111 Encounter for antineoplastic chemotherapy $16,108,783 3,130 $26,132 $4,938 $5,147 $19,001 $20,474
G35 Multiple sclerosis $4,462,517 694 $25,087 $4,841 $6,430 $0 $15,597
Z510 Encounter for antineoplastic radiation therapy $4,202,500 821 $22,784 $3,343 $5,119 $913 $13,804
T82858A Stenosis of other vascular prosth dev/grft, init $1,793,913 407 $22,841 $4,208 $4,408 $13,769 $22,887
G8929 Other chronic pain $1,769,593 2,502 $4,402 $714 $707 $11,238 $2,781
T82868A Thrombosis due to vascular prosth dev/grft, init $1,760,589 226 $39,533 $8,240 $7,790 $31,234 $30,579
Z1211 Encounter for screening for malignant neoplasm of colon $1,531,228 1,726 $5,084 $863 $887 $0 $5,560
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,357,754 248 $46,826 $5,794 $5,475 $16,586 $38,515
R0789 Other chest pain $1,321,029 975 $12,897 $1,452 $1,355 $14,879 $8,970
M1711 Unilateral primary osteoarthritis, right knee $1,283,112 180 $61,706 $10,612 $7,128 $43,435 $11,838
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,229,779 939 $10,670 $1,446 $1,310 $9,349 $6,561
C61 Malignant neoplasm of prostate $1,139,235 1,253 $6,112 $840 $909 $18,439 $5,300
R079 Chest pain, unspecified $1,132,915 902 $11,514 $1,363 $1,256 $4,183 $7,237
M1712 Unilateral primary osteoarthritis, left knee $1,132,885 178 $55,601 $9,498 $6,365 $38,644 $12,308
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $867,293 46 $107,801 $17,987 $18,854 $0 $16,741
R55 Syncope and collapse $830,285 617 $12,086 $1,263 $1,346 $3,006 $8,288
I480 Paroxysmal atrial fibrillation $811,764 601 $11,347 $2,001 $1,351 $0 $5,054
J4550 Severe persistent asthma, uncomplicated $810,132 215 $13,190 $2,700 $3,768 $0 $9,394
G4733 Obstructive sleep apnea (adult) (pediatric) $765,729 1,376 $2,464 $429 $556 $0 $2,522
  All Other $80,689,286 105,321 - - - - -
  Unclassified Services $128,824 94 - - - - -
  TOTAL FOR ALL CLAIMS $142,479,749 124,484 - - - - -

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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 $6,975,111 3,240 3,240 $1,701 $234 $2,153 $2,569
1490 Inj pembrolizumab $5,679,286 627 159,690 $154 $32 $36 $192
5115 Level 5 Musculoskeletal Procedures $4,222,783 439 439 $10,334 $1,573 $9,619 $14,827
5193 Level 3 Endovascular Procedures $4,094,748 468 468 $17,383 $2,090 $8,749 $23,243
9453 Injection, nivolumab $3,610,178 415 181,441 $86 $18 $20 $109
9494 Injection, ocrelizumab $2,988,738 98 54,600 $176 $37 $55 $212
5012 Clinic Visits and Related Services $2,974,189 24,646 30,029 $136 $79 $99 $189
5114 Level 4 Musculoskeletal Procedures $2,532,730 496 496 $6,667 $1,015 $5,106 $11,404
9214 Bevacizumab injection $2,270,746 341 38,697 $259 $54 $59 $335
5694 Level 4 Drug Administration $2,232,980 5,151 8,535 $573 $90 $262 $978
9186 Inj., rituximab, 10 mg $2,212,734 323 32,527 $306 $63 $68 $382
5192 Level 2 Endovascular Procedures $2,168,076 511 511 $12,450 $1,816 $4,243 $14,228
5572 Level 2 Imaging with Contrast $2,118,705 6,077 6,091 $4,214 $155 $348 $4,848
5024 Level 4 Type A ED Visits $2,046,401 6,297 6,299 $1,600 $220 $325 $1,857
5524 Level 4 Imaging without Contrast $2,017,654 4,489 4,491 $4,312 $613 $449 $2,669
5594 Level 4 Nuclear Medicine and Related Services $1,979,469 1,586 1,586 $7,553 $1,001 $1,248 $7,343
5693 Level 3 Drug Administration $1,963,366 8,865 11,638 $459 $65 $169 $497
5593 Level 3 Nuclear Medicine and Related Services $1,961,008 1,769 1,769 $4,873 $646 $1,109 $4,960
5623 Level 3 Radiation Therapy $1,947,677 553 4,122 $2,131 $303 $473 $3,729
5194 Level 4 Endovascular Procedures $1,818,073 132 132 $22,637 $2,925 $13,773 $27,559
  TOTAL FOR TOP 20 $57,814,652 66,523 546,801 - - - -
  SERVICE MIX INDEX = 5.893        

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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 22,319 51,666 $51 $10 $0 0.00
IV Therapy 34,666 66,397 $329 $47 $45 1.01
Medical Surgical Supplies 34,111 74,785 $1,637 $364 $4 33.18
Laboratory 272,095 336,808 $205 $12 $2 1.87
Laboratory - Pathological 7,681 13,908 $458 $26 $5 3.42
Radiology - Diagnostic 24,525 25,717 $519 $69 $45 1.49
Radiology - Therapeutic 14,555 31,824 $985 $140 $240 3.84
Nuclear Medicine 9,809 14,622 $1,175 $156 $161 11.69
CT Scan 26,149 26,240 $2,912 $81 $148 3.05
Operating Room Services 26,909 29,391 $3,636 $553 $1,445 26.18
Anesthesia 10,799 587,627 $26 $4 $0 0.00
Blood Storage and Processing 1,407 2,447 $991 $141 $248 3.48
Other Imaging Services 10,914 10,948 $1,676 $222 $238 5.68
Respiratory Services 4,832 9,805 $272 $30 $33 1.03
Physical Therapy 6,071 8,970 $207 $53 $19 11.25
Occupational Therapy 1,611 2,345 $215 $37 $26 0.00
Speech-Language Pathology 774 853 $497 $79 $41 0.00
Emergency Room 18,445 18,463 $1,541 $212 $610 8.35
Pulmonary Function 2,840 3,263 $394 $56 $42 2.72
Cardiology 10,943 10,952 $3,172 $451 $208 6.09
Cardiac Cath Lab 1,168 1,180 $21,164 $1,651 $4,509 82.20
Clinic 24,827 30,306 $137 $79 $99 1.44
Magnetic Resonance Technology (MRT) 8,566 8,633 $4,030 $189 $249 4.33
Drugs Requiring Specific Identification 169,706 6,824,452 $35 $7 $7 0.00
Recovery Room 10,537 778,145 $15 $3 $0 0.00
EKG/ECG (Electrocardiogram) 16,453 20,477 $342 $20 $7 0.89
EEG (Electroencephalogram) 458 479 $1,417 $222 $185 4.62
Observation Room 5,566 193,206 $66 $9 $0 27.27
Treatment Room 2,904 3,476 $248 $144 $59 1.68
Lithotripsy 143 143 $14,478 $2,057 $2,373 37.36
Psychiatric / Psychological Treatments 13 13 $805 $123 $415 6.01
Other Diagnostic Services 8,190 8,390 $1,188 $161 $170 3.26
Other Therapeutic Services 152 942 $233 $26 $51 0.68
Other Therapeutic - Cardiac Rehab 910 6,783 $184 $107 $107 1.36
Unclassified 1,655 1,734 $201 $43 $25 0.69
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