Outpatient Utilization

Based on Medicare OPPS claims data

  • Medicare OPPS claims data are for calendar year ending 12/31/2022 (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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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 $30,117,519 3,581 $35,625 $7,081 $8,410 $2,340 $42,142
Z5111 Encounter for antineoplastic chemotherapy $19,077,497 5,569 $18,117 $3,509 $3,426 $3,191 $23,014
G35 Multiple sclerosis $3,630,313 741 $22,427 $4,286 $4,899 $0 $19,491
Z510 Encounter for antineoplastic radiation therapy $3,313,866 620 $24,275 $4,018 $5,345 $0 $16,476
M1711 Unilateral primary osteoarthritis, right knee $2,516,346 258 $83,591 $16,346 $9,753 $260,006 $21,404
M1712 Unilateral primary osteoarthritis, left knee $2,326,935 229 $88,367 $17,340 $10,161 $256,452 $21,772
G8929 Other chronic pain $2,017,440 2,753 $3,993 $775 $733 $0 $3,373
Z1211 Encounter for screening for malignant neoplasm of colon $1,742,696 1,765 $5,904 $1,153 $987 $3,655 $6,765
M810 Age-related osteoporosis w/o current pathological fracture $1,616,258 1,868 $4,085 $799 $865 $0 $2,538
M1611 Unilateral primary osteoarthritis, right hip $1,495,917 198 $70,752 $13,723 $7,555 $88,605 $25,268
E0500 Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis $1,412,694 37 $136,910 $27,841 $38,181 $0 $9,916
U071 COVID-19 $1,388,140 1,647 $4,479 $708 $843 $0 $4,491
I25110 Athscl heart disease of native cor art w unstable ang pctrs $1,387,989 222 $53,343 $7,620 $6,252 $44,752 $42,570
I2510 Athscl heart disease of native coronary artery w/o ang pctrs $1,376,905 703 $16,751 $2,350 $1,959 $30,728 $7,194
T82858A Stenosis of other vascular prosth dev/grft, init $1,223,526 261 $23,831 $5,338 $4,688 $2,387 $26,021
C61 Malignant neoplasm of prostate $1,196,841 1,391 $7,677 $1,222 $860 $23,047 $6,678
Z4502 Encntr for adjust and mgmt of automatic implntbl card defib $1,172,771 48 $127,346 $23,291 $24,433 $0 $21,600
M1612 Unilateral primary osteoarthritis, left hip $1,162,907 162 $67,194 $13,054 $7,178 $68,014 $25,892
I480 Paroxysmal atrial fibrillation $1,134,928 550 $15,495 $3,086 $2,064 $0 $7,257
R079 Chest pain, unspecified $1,123,433 960 $10,761 $1,407 $1,170 $0 $7,277
  All Other $100,574,263 112,468 - - - - -
  Unclassified Services $0 0 - - - - -
  TOTAL FOR ALL CLAIMS $181,009,184 136,031 - - - - -

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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 $12,126,620 1,063 1,063 $13,922 $2,551 $11,408 $21,264
8011 Comprehensive Observation Services $7,774,022 3,692 3,692 $1,735 $328 $2,106 $3,098
5193 Level 3 Endovascular Procedures $3,454,358 373 373 $17,726 $2,150 $9,261 $26,691
5012 Clinic Visits and Related Services $2,760,680 26,702 29,173 $133 $64 $95 $213
5213 Level 3 Electrophysiologic Procedures $2,757,720 140 140 $38,115 $3,011 $19,698 $52,221
5694 Level 4 Drug Administration $2,707,309 8,111 9,161 $602 $107 $296 $1,211
5114 Level 4 Musculoskeletal Procedures $2,596,861 449 560 $5,574 $1,021 $4,637 $13,786
5232 Level 2 ICD and Similar Procedures $2,378,456 78 78 $20,580 $3,770 $30,493 $54,803
5524 Level 4 Imaging without Contrast $2,137,934 4,775 4,800 $4,141 $672 $445 $3,078
5693 Level 3 Drug Administration $2,113,612 10,981 11,221 $494 $80 $188 $611
5594 Level 4 Nuclear Medicine and Related Services $2,058,664 1,503 1,503 $7,955 $1,176 $1,370 $8,307
5623 Level 3 Radiation Therapy $2,028,371 550 4,060 $2,213 $359 $500 $4,417
5024 Level 4 Type A ED Visits $1,779,858 5,282 5,282 $1,600 $302 $337 $2,264
5572 Level 2 Imaging with Contrast $1,726,111 5,279 5,295 $4,451 $213 $326 $5,346
5593 Level 3 Nuclear Medicine and Related Services $1,722,274 1,430 1,431 $5,136 $759 $1,204 $5,588
5192 Level 2 Endovascular Procedures $1,672,892 366 366 $14,011 $2,167 $4,571 $16,507
5442 Level 2 Nerve Injections $1,605,722 2,710 2,828 $2,664 $488 $568 $2,578
5194 Level 4 Endovascular Procedures $1,595,075 108 110 $22,136 $3,065 $14,501 $32,077
5183 Level 3 Vascular Procedures $1,536,529 581 581 $5,093 $923 $2,645 $8,752
5312 Level 2 Lower GI Procedures $1,512,957 1,402 1,737 $2,781 $509 $871 $3,638
  TOTAL FOR TOP 20 $58,046,025 75,575 83,454 - - - -
  SERVICE MIX INDEX = 6.363        

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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 34,815 111,022 $38 $8 $0 0.00
IV Therapy 34,368 51,173 $359 $58 $64 1.08
Medical Surgical Supplies 33,851 86,293 $2,264 $516 $7 114.20
Laboratory 267,202 326,580 $221 $14 $3 1.91
Laboratory - Pathological 7,167 13,798 $473 $29 $4 3.23
Radiology - Diagnostic 22,959 25,011 $520 $77 $49 1.57
Radiology - Therapeutic 20,254 32,575 $1,050 $170 $267 3.87
Nuclear Medicine 12,635 18,736 $922 $136 $116 11.43
CT Scan 41,334 45,175 $1,825 $56 $78 2.82
Operating Room Services 26,146 28,535 $3,990 $731 $1,748 29.29
Anesthesia 10,257 613,074 $27 $4 $0 0.00
Blood Storage and Processing 1,705 2,275 $1,035 $168 $251 3.61
Other Imaging Services 14,217 14,253 $1,500 $222 $232 5.74
Respiratory Services 3,412 8,006 $275 $35 $32 0.75
Physical Therapy 10,512 16,321 $217 $56 $21 0.00
Occupational Therapy 3,886 5,551 $232 $46 $28 0.00
Speech-Language Pathology 864 1,018 $537 $108 $49 0.00
Emergency Room 16,121 16,125 $1,575 $298 $705 9.80
Pulmonary Function 2,843 4,042 $372 $60 $47 1.77
Cardiology 10,855 10,868 $3,232 $524 $218 5.86
Cardiac Cath Lab 1,272 1,303 $21,489 $1,698 $5,216 98.95
Clinic 26,894 29,444 $135 $64 $95 1.45
Magnetic Resonance Technology (MRT) 14,557 15,029 $2,454 $150 $136 4.07
Drugs Requiring Specific Identification 157,192 7,158,701 $52 $11 $10 0.00
Recovery Room 10,171 824,567 $16 $4 $0 0.00
EKG/ECG (Electrocardiogram) 14,917 18,878 $341 $22 $9 0.81
EEG (Electroencephalogram) 385 396 $1,253 $191 $176 3.67
Observation Room 5,884 254,085 $69 $11 $0 0.00
Treatment Room 2,601 2,716 $398 $190 $147 2.40
Lithotripsy 149 149 $15,202 $2,467 $2,718 37.65
Other Diagnostic Services 6,718 6,842 $1,216 $186 $167 3.09
Other Therapeutic - Cardiac Rehab 848 6,043 $193 $92 $108 1.41
Unclassified 2,348 2,492 $395 $129 $132 0.90
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
Other Therapeutic Services 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