New Mapping Tool - CPT/HCPCS Medicare Denial Rates & Average Charges

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
November 29th, 2016

Use this tool as a part of an important strategy to improve your processes and stay ahead of denials. Check your most commonly used codes to give your practice a heads up on denial rates and average charges. This is a quick way to view a group of codes or a single code showing denial rates and average charges on claims submitted to Medicare using the last 8 years of Medicare data.  

Once you gather your codes do a self audit on the codes showing the highest denial rates to see how you are doing.

Here is how…

Enter your codes in the Box, chose the year you wish to view, then chose your specialty or National Average.

Map a code

Now export your data to a Excel/CSV file and sort the column showing the percentages of denials. Now focus your attention on the codes with the highest denial rates and compare the data with your claims.

Code Set Code Descr Denial % Average Charge
CPT 11313 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM 50.00% $217.86
CPT 15040 HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/< 42.00% $620.04
CPT 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 14.00% $67.74
CPT 99214 OFFICE OUTPATIENT VISIT 25 MINUTES 7.00% $167.78
CPT 99212 OFFICE OUTPATIENT VISIT 10 MINUTES 6.00% $70.51
CPT 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE 5.00% $211.04
CPT 11760 REPAIR NAIL BED 5.00% $279.91

Compare your fees to ensure you are receiving proper reimbursement.

How are your codes are being paid – where are the denials coming from?

Use this Find-A-Code exclusive tool as a part of your Denial Management!

New Mapping Tool - CPT/HCPCS Medicare Denial Rates & Average Charges. (2016, November 29). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/new-mapping-tool-cpt-hcpcs-medicare-denial-rates-average-charges-30074.html

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