Comparative Billing Reports

CBR201511 Statistical Debriefing

CBR201511

The following is a description of the tables used in CBR201511: 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 CBR201511. All of the analyses in this comparative billing report (CBR) include only the Current Procedural Terminology (CPT®) Codes 97001, 97035, 97110, 97112, 97140, and 97530. Claims were limited to rendering national provider identifier (NPI) specialty ‘65’ and with modifier ‘GP’.  CBR201511 includes claims with dates of service January 1, 2014 to December 31, 2014.  These analyses are based on the latest version of claims available from the Integrated Data Repository as of October 12, 2015. In the CBR201511 sample examples of each table can be found.

 

Summary of Your Utilization

Table 1 of CBR201511 provides a list of the CPT® codes used in this CBR.  This table includes an abbreviated description and the summary statistics for an individual provider for each CPT® code. The total allowed charges, allowed services, distinct beneficiary counts, and the number of visit for each row of the table. The visit count is only provided for the timed procedures since multiple services are likely to be billed on the same visit for these CPT® codes. Please note that the total row may not equal the sum of the rows for the beneficiary and visit count columns. The number of beneficiaries and visits are unduplicated counts for each row and the total.  The total visit count includes only those visits with timed procedures.

 

Percentage of Beneficiaries with Modifier KX

Table 2 provides an analysis of the percentage of beneficiaries with modifier KX. This percentage is calculated as the number of beneficiaries with modifier KX divided by the total number of beneficiaries, and then multiplied by 100. The number of beneficiaries with modifier KX includes all of the beneficiaries with allowed charges for the CPT® codes included in this CBR that have at least one claim line appended with the KX modifier. The total number of beneficiaries is the number of beneficiaries that have allowed charges for any of the CPT® codes included in this CBR. Each provider’s percentage is compared to his state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentages of beneficiaries with modifier KX for all states and the nation, please select the following link: CBR201511 Percentage of Beneficiaries with Modifier KX

 

Average Allowed Minutes per Visit for Selected CPT® Codes

Table 3 provides an analysis of the average allowed minutes per visit. It is calculated as the “Total Weighted Services for the Selected CPT® Codes” divided by the “Total Number of Visits with the Selected CPT® Codes”. Each provider’s average is compared to his state and the nation using the t-test at the alpha value of 0.05.

 

To calculate the numerator, or “Total Weighted Services for the Selected CPT® Codes,”

First sum the number of services for CPT® codes 97035, 97110, 97112, 97140, and 97530. Multiply this sum by 15 minutes, since each allowed service represents a 15 minute increment. Next we calculate the denominator, “Total Number of Visits with the Selected CPT® Codes.” This is the number of unique dates of service for each beneficiary (or total visits) for these selected codes.

 

To view the average allowed minutes per visit for selected CPT® codes for each state and the nation, please select the following link:  CBR201511 Average Allowed Minutes per Visit for Selected CPT Codes

 

Average Allowed Charges per Beneficiary

Table 4 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 services and beneficiaries for the CPT® codes included in this CBR for the services allowed with dates of services in 2014. Each provider’s percentage is compared to his 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:  CBR201511 Average Allowed Charges per Beneficiary