Comparative Billing Reports

CBR201702 Statistical Debriefing

CBR201702

The following is a description of the tables used in CBR201702, Physical Therapy. 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 CBR201702. This CBR examines physical therapy services billed with Current Procedural Terminology (CPT®) codes 97001, 97002, 97035, 97110, 97112, 97140, 97530, and Healthcare Common Procedure Code System (HCPCS) code G0283 billed with the GP modifier, signifying services delivered under an outpatient physical therapy plan of care. CBR201702 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 (IDR) as of December 8, 2016. Examples of each table can be found in the CBR201702 sample.

 

CPT®/HCPCS Codes and Abbreviated Descriptions

Table 1 of CBR201702 lists each of the CPT®/ HCPCS codes covered in this CBR with the abbreviated description.

 

Summary of Your Utilization

Table 2 provides a summary of your utilization of the procedure codes included in this CBR. The total allowed charges, allowed services, distinct beneficiary count and visit count are included for each procedure code. The visit count is only provided for the timed procedures since multiple services are likely to be billed on the same visit for these procedure codes. In addition, an overall “Total” row is included. Please note that the totals may not be equal to the sum of the rows due to rounding. Also, the number of visits and beneficiaries are unduplicated counts for each row and the total. A beneficiary receiving multiple items in the list would be counted in the beneficiary count in each applicable row; however, this beneficiary would be counted only once in the total row.

 

Percentage of Beneficiaries with KX Modifier

Table 3 provides an analysis of the percentage of beneficiaries with KX modifier. The KX modifier indicates that the services are at or above the therapy caps. This metric was designed to focus on providers that are billing this modifier at rates above their peers. Although adding this modifier is justifiable, the percentage of beneficiaries needing additional care should be comparable across providers in the peer groups. The percentage of beneficiaries with KX modifier appended is calculated by taking the number of beneficiaries with the KX modifier divided by total number of beneficiaries 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 beneficiaries with KX modifier for each state and the nation, please select the following link: CBR201702 Percentage of Beneficiaries with KX Modifier.xls.

 

Average Minutes per Visit

Table 4 provides an analysis of the average minutes per visit. The average minutes per visit is calculated for each provider of physical therapy to identify potential overutilization of these services. Since each service submitted under CPT® codes 97035, 97110, 97112, 97140, and 97530 typically represent 15 minutes with the patient, this measure is an average of all services, with the associated minutes, that the physical therapist spends with the patient on a visit. This measure is calculated by taking the total allowed services for selected CPT® codes, multiplying the sum of services by 15 minutes, then dividing by the total number of visits. A visit is defined as a single date of service between each beneficiary and the provider. Each provider’s percentage is compared to his/her state and the nation using t-test at the alpha value of 0.05.

To view the average minutes per visit for all states and the nation, please select the following link: CBR201702 Average Minutes per Visit.xls.

 

Average Allowed Charges per Beneficiary

Table 5 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 state 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: CBR201702 Average Allowed Charges per Beneficiary.xls.