What's your organization's CPT code mix?

Financial Opportunity in the selected CPT Category

Select a specific facility to compare CPT-code mix with the leading facility.

Simulating charges with a more optimal coding mix

Table compares actual CPT counts with simulated counts using the leading facility distribution.

* Medicare payments vary by geography, place of service, and billing modifiers. Because this analysis is focused on differences from E/M level selection, we remove those other factors and use unweighted payments. Your actual payments likely differ from the values used in this estimate.

† Estimated value for an organization that sees 40% Medicare patients.

‡ ABSENCE OF 99291 represents encounters where 99291 could have been used but was not. While not all such cases warrant critical care coding, this group serves as a useful comparison denominator. It includes codes 99281–99285, 99221–99223, and 99231–99236. Payment is set as a weighted-average replacement based on this code mix.

‡ ABSENCE OF G2211 represents the pool of encounters for which the longitudinal service code G2211 could have been used but was not. Although it's not appropriate in all these cases, it serves as a useful denominator for comparison. This is calculated as: sum(99241,99242,99243,99244,99245,99211,99212,99213,99214,99215,99201,99202,99203,99204,99205) - sum(G2211), keeping only positive results.

‡ ABSENCE OF G2212 represents the pool of encounters for which the prolonged service code G2212 could have been used but was not. Although it's not appropriate in all these cases, it serves as a useful denominator for comparison. This is calculated as: sum(99215,99205) - sum(G2212)

Have questions about applying these findings in your organization?

Phrase Health can help you understand this variation in billing, and make adjustments to your coding workflows to improve consistency and reimbursement outcomes.