Comparative Billing Reports

CBR201709 Statistical Debriefing

CBR201709

The following is a description of the tables used in CBR201709 Emergency Department Services. 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 CBR201709. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) Codes 99281-99285. CBR201709 includes claims with dates of service July 1, 2016 to June 30, 2017.  These analyses are based on the latest version of claims available from the Integrated Data Repository as of September 12, 2017. Examples of each table can be found in the CBR201709 sample.

 

CPT® Codes, History/Examination, and Medical Decision Making

Table 1 of CBR201709 provides a listing of the CPT® codes analyzed in this report. This table also includes a history/examination of each code and the medical decision making required for emergency department services.

 

Summary of Your Utilization of Emergency Department Services

Table 2 provides the statistics summary for the individual provider for each CPT® code analyzed in the CBR. The total allowed charges, allowed services, distinct visit count, and distinct beneficiary count are included for each CPT® code. Please note the totals may not be equal to the sum of the rows due to rounding. For example, a beneficiary of multiple services with different CPT® codes within this time period 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 Services Billed with CPT® Code 99285

Table 3 provides an analysis of the percentage of services billed with CPT® code 99285. This percentage is calculated as the number of services with CPT® code 99285 divided by the total number of services, and then multiplied by 100. 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 billed with CPT Code 99285 for all states and the nation, please select the following link: CBR201709 Percentage of Services Billed with CPT Code 99285.xls.

 

Percentage of Services Appended with Modifier 25

Table 4 provides an analysis of the percentage of services appended 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 appended with modifier 25 for all states and the nation, please select the following link: CBR201709 Percentage of Services Appended with Modifier 25.xls.

 

Average Allowed Charges for all Medicare Part B Services per Visit

Table 5 provides an analysis of the average allowed charges for all Medicare Part B services per visit submitted by the same provider on the same date of service as the emergency department (ED) service. It is calculated as total allowed charges for all Part B services at ED divided by the total number of visits. 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 for all Medicare Part B services per visit for each state and the nation, please select the following link: CBR201709 Average Allowed Charges for all Medicare Part B Services per Visit.xls.