ED Coding and Reimbursement Alert

In addition to its overview of the results, RELI Group released a spreadsheet showing state-specific data. ED Coding Alert crunched the numbers on the data to determine where the highest and lowest billing patterns are taking place for three key criteria.

For the overall percentage of services billed with 99285, the national average was 46.53 percent, but some states logged higher and lower rates than that, as follows:

Highest states: Percentage of services billed with 99285

Florida: 54.63 percent
Nevada: 53.50 percent
Tennessee: 52.58 percent
Virginia: 49.80 percent
Illinois: 49.62 percent

Lowest states: Percentage of services billed with 99285

Puerto Rico: 18.41 percent
Virgin Islands: 23.41 percent
South Dakota: 26.65 percent
Nebraska: 26.79 percent
Guam: 29.01 percent

When it comes to the percentage of services appended with modifier 25, the national average was 10.44 percent, but some states logged higher and lower rates than that, as follows:

Highest states: Percentage of services appended with modifier 25

Guam: 19.76 percent
West Virginia: 16.84 percent
Wisconsin: 16.03 percent
Iowa: 15.44 percent
Colorado: 14.80 percent

Lowest states: Percentage of services appended with modifier 25

North Dakota: 6.06 percent
Nevada: 6.27 percent
Idaho: 6.32 percent
Nebraska: 7.24 percent
New Mexico: 7.29 percent

In terms of the average allowed charges for all Part B services (per visit), the national average was $126.93, but some states fell outside of that range, as follows:

Highest states: Average allowed charges for all Medicare Part B services, per visit

Alaska: $149.21
Florida: $135.31
New Jersey: $133.84
Illinois: $133.49
Michigan: $133.20

Lowest states: Average allowed charges for all Medicare Part B services, per visit

Virgin Islands: $91.09
Puerto Rico: $94.51
South Dakota: $99.44
Nebraska: $100.01
Kansas: $106.52