• Medicare OPPS claims data are for calendar year ending 12/31/2020 (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 $20,988,320 2,359 $42,872 $9,312 $8,897 $3,854 $36,621
Z5111 Encounter for antineoplastic chemotherapy $16,096,200 3,102 $30,256 $6,288 $5,189 $28,242 $21,381
Z510 Encounter for antineoplastic radiation therapy $4,719,886 786 $25,734 $4,152 $6,005 $12,500 $14,304
G35 Multiple sclerosis $4,336,853 598 $31,426 $6,612 $7,252 $0 $18,873
M1611 Unilateral primary osteoarthritis, right hip $2,039,520 218 $93,522 $17,349 $9,356 $85,066 $18,889
M1711 Unilateral primary osteoarthritis, right knee $1,850,306 203 $76,000 $14,033 $9,115 $37,683 $16,379
T82858A Stenosis of other vascular prosth dev/grft, init $1,775,582 404 $22,057 $4,428 $4,395 $5,983 $24,172
G8929 Other chronic pain $1,663,123 2,011 $4,712 $834 $827 $3,239 $3,138
M1612 Unilateral primary osteoarthritis, left hip $1,646,619 169 $97,905 $18,203 $9,743 $66,555 $19,665
M1712 Unilateral primary osteoarthritis, left knee $1,597,610 179 $75,387 $13,938 $8,925 $49,966 $16,802
T82868A Thrombosis due to vascular prosth dev/grft, init $1,436,006 177 $37,837 $8,273 $8,113 $1,332 $31,934
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,276,680 180 $57,344 $8,287 $7,093 $19,283 $41,013
Z1211 Encounter for screening for malignant neoplasm of colon $1,223,202 1,294 $5,881 $1,067 $945 $0 $6,008
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $1,062,903 44 $140,925 $24,977 $24,157 $0 $18,013
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,062,264 668 $12,538 $1,795 $1,590 $9,293 $6,696
R079 Chest pain, unspecified $1,029,967 808 $11,931 $1,496 $1,275 $9,909 $7,231
J4550 Severe persistent asthma, uncomplicated $951,339 235 $15,568 $3,469 $4,048 $0 $10,447
C61 Malignant neoplasm of prostate $907,769 1,065 $8,411 $1,296 $852 $32,707 $5,848
I480 Paroxysmal atrial fibrillation $814,019 473 $13,366 $2,575 $1,721 $0 $5,560
M810 Age-related osteoporosis w/o current pathological fracture $780,813 1,244 $3,524 $739 $628 $0 $2,171
  All Other $75,762,324 88,815 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $143,021,305 105,032 - - - - -

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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 $9,315,670 851 851 $12,793 $2,112 $10,947 $18,309
1490 Inj pembrolizumab $7,528,630 788 204,738 $182 $41 $37 $199
8011 Comprehensive Observation Services $5,794,633 2,865 2,865 $1,720 $248 $2,023 $2,686
5193 Level 3 Endovascular Procedures $3,738,658 409 409 $17,027 $2,198 $9,141 $24,252
9453 Injection, nivolumab $3,731,806 398 178,180 $102 $23 $21 $115
9494 Injection, ocrelizumab $3,137,706 103 56,100 $204 $46 $56 $215
5694 Level 4 Drug Administration $2,563,342 5,274 8,977 $604 $103 $286 $1,071
5012 Clinic Visits and Related Services $2,336,173 20,869 25,292 $136 $85 $92 $195
5114 Level 4 Musculoskeletal Procedures $2,208,741 408 408 $6,827 $1,127 $5,414 $12,172
5192 Level 2 Endovascular Procedures $2,150,232 471 471 $13,119 $2,020 $4,565 $14,829
5232 Level 2 ICD and Similar Procedures $2,034,837 69 69 $20,049 $3,310 $29,490 $48,396
9272 Inj, denosumab $1,945,838 1,596 136,020 $75 $17 $14 $81
9476 Injection, daratumumab 10 mg $1,892,348 245 47,577 $202 $45 $40 $228
5194 Level 4 Endovascular Procedures $1,790,869 123 123 $21,774 $2,748 $14,560 $29,112
5594 Level 4 Nuclear Medicine and Related Services $1,768,098 1,328 1,328 $7,946 $1,082 $1,331 $7,633
5572 Level 2 Imaging with Contrast $1,750,997 4,983 4,996 $4,432 $176 $350 $4,992
5524 Level 4 Imaging without Contrast $1,728,551 3,906 3,909 $4,174 $649 $442 $2,790
5213 Level 3 Electrophysiologic Procedures $1,726,715 93 93 $38,115 $3,141 $18,567 $41,596
5623 Level 3 Radiation Therapy $1,717,117 474 3,438 $2,221 $346 $499 $3,912
9492 Inj., durvalumab, 10 mg $1,706,547 142 22,633 $273 $61 $75 $311
  TOTAL FOR TOP 20 $60,567,508 45,395 698,477 - - - -
  SERVICE MIX INDEX = 6.360        

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  • (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 19,079 44,547 $61 $14 $0 0.00
IV Therapy 30,720 57,421 $349 $54 $44 0.99
Medical Surgical Supplies 30,431 72,802 $2,121 $471 $6 76.12
Laboratory 238,101 299,426 $218 $15 $2 1.61
Laboratory - Pathological 6,705 12,421 $472 $31 $5 3.40
Radiology - Diagnostic 19,411 20,507 $547 $75 $52 1.66
Radiology - Therapeutic 14,596 30,430 $1,034 $161 $270 4.04
Nuclear Medicine 11,690 17,256 $849 $116 $115 11.97
CT Scan 37,264 40,770 $1,705 $47 $80 3.08
Operating Room Services 23,441 25,857 $4,099 $677 $1,706 29.26
Anesthesia 8,948 532,038 $27 $4 $0 0.00
Blood Storage and Processing 1,280 2,263 $1,081 $168 $262 3.73
Other Imaging Services 11,170 11,209 $1,637 $223 $250 5.87
Respiratory Services 3,271 6,067 $325 $35 $40 1.26
Physical Therapy 6,945 10,591 $218 $56 $20 0.00
Occupational Therapy 1,857 2,708 $232 $43 $28 0.00
Speech-Language Pathology 684 810 $538 $92 $48 0.00
Emergency Room 14,634 14,643 $1,550 $224 $624 8.91
Pulmonary Function 2,329 2,865 $390 $61 $38 2.63
Cardiology 9,263 9,272 $3,127 $487 $206 5.96
Cardiac Cath Lab 969 1,000 $22,119 $1,823 $5,066 94.39
Clinic 21,153 25,682 $137 $85 $92 1.44
Magnetic Resonance Technology (MRT) 12,143 12,533 $2,355 $122 $142 4.32
Drugs Requiring Specific Identification 151,376 6,434,705 $46 $10 $8 3.24
Recovery Room 8,894 732,148 $16 $4 $0 0.00
EKG/ECG (Electrocardiogram) 12,850 15,957 $343 $20 $7 0.86
EEG (Electroencephalogram) 368 370 $1,287 $228 $172 3.58
Observation Room 5,008 180,948 $67 $10 $0 27.27
Treatment Room 2,362 2,887 $267 $167 $59 1.72
Lithotripsy 112 112 $15,202 $2,365 $2,480 37.36
Other Diagnostic Services 6,484 6,610 $1,213 $172 $162 3.05
Other Therapeutic Services 81 507 $245 $26 $51 0.68
Other Therapeutic - Cardiac Rehab 716 4,894 $193 $120 $102 1.36
Unclassified 1,526 1,582 $184 $45 $27 0.64
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