Comparative Billing Reports

CBR201613 Statistical Debriefing

CBR201613

The following is a description of the tables used in CBR201613, Modifier 25: Obstetrics/Gynecology (OB/GYN). There are links that will open the excel files that contain state and national statistics used in the analysis of rendering Part B providers for CBR201613. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) Codes 99211-99215. CBR201613 includes claims with dates of service January 1, 2015 to December 31, 2015. These analyses are based on the latest version of claims available from the Integrated Data Repository as of July 19, 2015. In the CBR201613 sample examples of each table can be found. 

 

CPT® Codes, Abbreviated Descriptions, and Typical Times

Table 1 of CBR201613 provides a listing of the CPT® codes analyzed in this report. This table also includes an abbreviated description of each code and the typical times required for each code, assigned by the CPT® manual.

 

Summary of Your Utilization for E/M Codes and Modifier 25

Table 2 provides the statistics summary for the individual provider for each CPT® code analyzed in the CBR. The total allowed charges, allowed services, and distinct beneficiary count are included for each CPT® code, both with and without modifier 25. Please note the totals may not be equal to the sum of the rows. The number of beneficiaries is an unduplicated count for each row and the total. It is likely that a beneficiary would have billings for more than one CPT® code and modifier type, he/she would be counted in the beneficiary count in each applicable row. This beneficiary would be counted only once in the total.

 

Percentage of Services with Modifier 25

Table 3 provides an analysis of the percentage of services with modifier 25. This percentage is calculated as the number of services with modifier 25 divided by the total number of services and then multiplied by 100. This calculation covers all of the CPT® codes included in this CBR. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentages of services with modifier 25 for all states and the nation, please select the following link: CBR201613 Percentage of Services with Modifier 25.xls.

 

Average Allowed Minutes per Visit with Modifier 25 and without Modifier 25

Table 4 provides an analysis of the average allowed minutes per visit with modifier 25 and without modifier 25. Each CPT® code is assigned a value that corresponds to the typical minutes described in the CPT® code description in table 1. This value is multiplied by the total allowed services for this code to arrive at the total weighted service per code. All weighted services are summed by modifier designation (with modifier 25 and without modifier 25) and divided by the total number of visits by modifier designation. A visit is defined as a single date of service by beneficiary. Generally, the total number of visits is equal to the total number of services by modifier designation. However, if multiple E/M services are allowed for a particular beneficiary and date of service, then these services would be combined in the same visit. The average minutes allowed per visit are calculated separately for services with modifier 25 and without modifier 25, as total E/M weighted services by modifier designation divided by total number of E/M visits by modifier designation. Each provider’s average is compared to his/her state and the nation using t-test at the alpha value of 0.05.

 

To view the average allowed minutes per visit with modifier 25 and without modifier 25 for each state and the nation, please select the following link: CBR201613 Average Allowed Minutes per Visit with Modifier 25 and without Modifier 25.xls.

 

Average Allowed Charges per Beneficiary

Table 5 provides an analysis of the average allowed charges per beneficiary. It is calculated as the “Total Allowed Charges” divided by the “Total number of Beneficiaries.” The calculation includes all allowed charges and beneficiaries for the CPT® codes included in this CBR for the services allowed with dates of service January 1, 2015 – December 31, 2015. Each provider’s average is compared to his/her state and the nation using the t-test at the alpha value of 0.05.

 

To view the average allowed charges per beneficiary for each state and the nation, please select the following link: CBR201613 Average Allowed Charges per Beneficiary.xls.