Comparative Billing Reports

CBR201616 Statistical Debriefing

CBR201616

The following is a description of the tables used in CBR201616, Viscosupplementation (VIS) of the Knee. 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 CBR201616. This CBR examines viscosupplementation services billed with Healthcare Common Procedure Coding System (HCPCS) codes J7321, J7323, J7324, J7325, J7326, J7327, and Current Procedural Terminology (CPT®) codes for injection services and established patient evaluation and management (E/M) services billed with these HCPCS codes. Only those services rendered in the office (place of service: 11) were included in the analyses. CBR201616 includes claims with dates of service July 1, 2015 to June 30, 2016. These analyses are based on the latest version of claims available from the Integrated Data Repository as of October 4, 2016. In the CBR201616 sample, examples of each table can be found. 

 

Category, HCPCS/CPT® Codes, and Abbreviated Descriptions

Table 1 of CBR201616 lists each of the HCPCS/ CPT® codes covered in this CBR with the category and abbreviated description.

 

Summary of Your Utilization

Table 2 provides a summary of your utilization of the HCPCS/ CPT® codes included in this CBR. The total allowed charges, allowed services, distinct visit count, and distinct beneficiary count are included for each HCPCS/CPT® code. Please note that the subtotals and totals may not be equal to the sum of the rows. The number of visits and beneficiaries are unduplicated counts for each row subtotal and total. Since it is possible that a beneficiary would have billings for more than one HCPCS / CPT® code, he/she would be counted in the beneficiary count in each applicable row. However, this beneficiary would be counted only once in the subtotal and total rows. It is also possible for a visit (or unique date of service) to be billed with multiple HCPCS and/or CPT® codes.

 

Percentage of Visits with Injection CPT® Code 20611

Table 3 provides an analysis of the percentage of Hyaluronan, or derivative, injection visits with injection CPT® code 20611. The percentage is calculated by taking the number of visits with CPT® code 20611 divided by total number of visits and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

To view the percentage of visits with injection CPT® code 20611 for each state and the nation, please select the following link: CBR201616 Percentage of Visits with Injection CPT Code 20611.xls.

 

Percentage of Visits with Other Injection CPT® Codes (76881, 76882, 76942, 77002)

Table 4 provides an analysis of the percentage of Hyaluronan, or derivative, injection visits with other injection CPT® code (76881, 76882, 76942, and 77002). The percentage is calculated by taking the number of visits with CPT® codes (76881, 76882, 76942, or 77002) divided by total number of visits and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

To view the percentage of visits with other injection CPT® code (76881, 76882, 76942, or 77002) for each state and the nation, please select the following link: CBR201616 Percentage of Visits with Other Injection CPT Codes.xls.

 

Percentage of Visits with Established Patient E/M CPT® Codes

Table 5 provides an analysis of the percentage of Hyaluronan, or derivative, injection visits with established patient E/M CPT® codes. The percentage is calculated by taking the number of visits with an E/M service divided by the total number of visits and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

To view the percentage of visits with established patient E/M CPT® codes for each state and the nation, please select the following link: CBR201616 Percentage of Visits with Established Patient CPT Codes.xls.

 

Average Allowed Charges per Beneficiary

Table 6 provides an analysis of the average allowed charges per beneficiary. The average allowed charges per beneficiary is calculated by taking the total allowed charges divided by total number of beneficiaries for all HCPCS and CPT® codes included in this report. Each provider’s average is compared to his/her and the nation using the t-test at the alpha value of 0.05.

To view the average allowed charges per beneficiary for all states and the nation, please select the following link: CBR201616 Average Allowed Charges per Beneficiary.xls.