Comparative Billing Reports

CBR201603 Statistical Debriefing

CBR201603

The following is a description of the tables used in CBR201603, Modifier 25: Internal Medicine.  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 CBR201603. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) Codes 99211-99215. CBR201603 includes claims with dates of service October 1, 2014 to September 30, 2015.  These analyses are based on the latest version of claims available from the Integrated Data Repository as of January 7, 2015. In the CBR201603 sample examples of each table can be found.

 

CPT® Codes, Abbreviated Descriptions, and Typical Times

Table 1 of CBR201603 provides a listing of the CPT® codes analyzed in this report.  This table also includes an abbreviated description of each code and the typical times required for each code.

 

Summary of Your Utilization

Table 2 of CBR201603 provides the summary statistics for an individual provider for each CPT® code and type combination. The total allowed charges, allowed services, and distinct beneficiary counts are provided for each row of the table. Each CPT® code has utilization summaries for services performed both with and without modifier 25. Please note that the total row may not equal the sum of the rows for the beneficiary column. The number of beneficiaries is an unduplicated count for each row and the total.

 

Percentage of Services with Modifier 25

Table 3 provides an analysis of the percentage of services with modifier 25. This percentage is calculated as the “total 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 state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentages of services with modifier 25 for all states and the nation, please select the following link: CBR201603 Percentage of Services with Modifier 25.xls.

 

Average Allowed Minutes per Visit

Table 4 provides an analysis of the average allowed minutes per visit with modifier 25 and without modifier 25. The averages are calculated separately for claim lines with modifier 25 and without modifier 25. It is calculated as the “Total E/M Weighted Services by Modifier Designation” divided by the “Total Number of E/M Visits by Modifier Designation.” 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 E/M Weighted Services by Modifier Designation,” each CPT® code is assigned a value that corresponds to the typical minutes described in the CPT® code description. The typical minutes can be found in Table 1 on the sample CBR. This value is multiplied by the number of services on the claim line. If multiple claim lines are allowed for a particular beneficiary and date of service then these lines are added together to get a total weighted value for each visit.  Next we calculate the denominator, “Total Number of E/M Visits by Modifier Designation.” This is the number of unique dates of service for each beneficiary or total visits.

 

To view the average allowed minutes per visit with modifier 25 and without modifier 25 for each state and the nation, please select the following link: CBR201603 Average Allowed Minutes per Visit.xls.

 

 

Average Allowed Charges per Beneficiary

Table 5 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 allowed charges and beneficiaries for the CPT® codes included in this CBR for the services allowed with dates of service October 1, 2014 – September 30, 2015. 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: CBR201603 Average Allowed Charges per Beneficiary.xls.