Tip: Measure your stats against outliers in your state.
In addition to its overview of the results, RELI Group Inc. released a spreadsheet showing state-specific data. We crunched the numbers on the data to determine where the highest and lowest billing patterns are taking place for three key criteria.
CPT® code 99285: For the overall percentage of services billed with 99285 (Emergency department visit for the evaluation and management of a patient...), the national average was 46.53 percent, but some states logged higher and lower rates than that. Review the results below:
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Highest and Lowest States’ Percentages of Services Billed with 99285
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Highest States
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Lowest States
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Florida: 54.63 percent
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Puerto Rico: 18.41 percent
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Nevada: 53.50 percent
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Virgin Islands: 23.41 percent
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Tennessee: 52.58 percent
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South Dakota: 26.65 percent
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Virginia: 49.80 percent
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Nebraska: 26.79 percent
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Illinois: 49.62 percent
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Guam: 29.01 percent
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*Data from RELI Group Inc. CBR 201906 Metric 1: Percentage of services billed with CPT® code 99285
Modifier 25: When it comes to the percentage of services appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service), the national average was 10.44 percent, but some states logged higher and lower rates than that, as follows:
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Highest and Lowest States’ Percentages of Services Appended with Modifier 25
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Highest States
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Lowest States
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Guam: 19.76 percent
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North Dakota: 6.06 percent
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West Virginia: 16.84 percent
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Nevada: 6.27 percent
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Wisconsin: 16.03 percent
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Idaho: 6.32 percent
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Iowa: 15.44 percent
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Nebraska: 7.24 percent
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Colorado: 14.80 percent
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New Mexico: 7.29 percent
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*Data from RELI Group Inc. CBR 201906 Metric 2: Percentage of services billed with Modifier 25
Part B services: 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:
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Highest and Lowest States’ Average Allowed Charges for All Medicare Part B Services, Per Visit
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Highest States
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Lowest States
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Alaska: $149.21
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Virgin Islands: $91.09
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Florida: $135.31
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Puerto Rico: $94.51
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New Jersey: $133.84
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South Dakota: $99.44
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Illinois: $133.49
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Nebraska: $100.01
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Michigan: $133.20
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Kansas: $106.52
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*Data from RELI Group Inc. CBR 201906 Metric 3: Average Allowed Charges for all Medicare Part B Services, per visit
Resource: For more on the findings of this comparative billing report, visit https://cbr.cbrpepper.org/About-CBR/CBR-201906.
