Comparative Billing Reports

CBR201707 Statistical Debriefing

CBR201707

The following is a description of the tables used in CBR201707, Initial Preventive Physical Examination/Annual Wellness Visits (IPPE/AWV). There are links that will open the excel files that contain state and national statistics used in the analysis of rendering Medicare Part B providers for CBR201707. The analyses in this Comparative Billing Report (CBR) focus on the HealthCare Common Procedural Coding System (HCPCS) codes G0402, G0438 and G0439. CBR201707 includes claims with dates of service from April 1, 2016 to March 31, 2017. These analyses are based on the latest version of claims available from the Integrated Data Repository as of July 6, 2017. Examples of each table can be found in the CBR201707 sample.

 

HCPCS Codes and Abbreviated Descriptions

Table 1 of CBR201707 lists each of the HCPCS codes and an abbreviated description for each of the codes covered in this CBR.

 

Summary of Your Utilization of IPPE/AWV

Table 2 provides a summary of your utilization of the procedure codes included in this CBR. The total allowed charges, allowed services, and distinct beneficiary counts are included for each procedure code. 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 beneficiary count is an unduplicated count for each row and the total. For example, a beneficiary receiving multiple HCPCS codes within this time period would be counted only once in the total row.

 

Percentage of Services Submitted with E/M, by HCPCS Code

Table 3 provides an analysis of the percentage of services submitted with an E/M code, by HCPCS code. An E/M service may be billed with the IPPE/AWV code only if a significant, separately identifiable, medically necessary problem is addressed during the visit. The percentage of services submitted with an E/M code is calculated for each IPPE/AWV HCPCS code by dividing the number of services submitted with an E/M code by the total number of services, and then multiplying by 100. The number of services submitted with an E/M code and the total number of services are provided in the table for each of the IPPE/AWV HCPCS code. 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 percentage of services submitted with E/M by HCPCS code for each state and the nation, please select the following link: CBR201707 Percentage of Services Submitted with E/M by HCPCS Code.xls.

 

Average Allowed Charges of All Medicare Part B Services per Beneficiary Submitted with each HCPCS Code

Table 4 provides an analysis of the average allowed charges of all Medicare Part B services per beneficiary submitted with each IPPE/AWV HCPCS code. The goals of the IPPE/AWV are health promotion, disease prevention, and detection. While the IPPE/AWV codes cover various elements of the exam, the provider may perform additional screenings or preventative services that would be billed separately. The average allowed charges of all Medicare Part B services per beneficiary for each IPPE/AWV HCPCS code is calculated by dividing the total allowed charges for all Part B services submitted at the time of the IPPE/AWV (by the same provider and date of service) by the total number of beneficiaries. The total allowed charges and number of beneficiaries are provided in the table for each IPPE/AWV HCPCS code. 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 of all Medicare Part B services per beneficiary submitted with each HCPCS code for all states and the nation, please select the following link: CBR201707 Average Allowed Charges of All Medicare Part B Services per Beneficiary Submitted with each HCPCS Code.xls.