E/M Comparative Billing Reports: Peer Code Comparison

Published 12/28/2020

The Evaluation and Management (E/M) Comparative Billing Reports: Peer Code Comparison is complete for South Carolina (S.C.), North Carolina (N.C.), Virginia (Va.), and West Virginia (W.Va.). The reports are based on the Part B National Summary Data file for January through July, 2020.

The report includes data for the following E/M families:

  • 92002 and 92004
  • 99201–99205
  • 99212–99215 with provider specialty not 18 or 41
  • 92012–92014 with provider specialty not 18 or 41
  • 92012, 92014, 99212–99215 with specialty code 18 or 41
  • 99221–99223
  • 99231–99233
  • 99238–99239
  • 99281–99285
  • 99304–99306
  • 99307–99310

The attached files contain the following variables:

  • Specialty Code: Provider specialty as it appears in the Part B National Summary Data file
  • Specialty Description: Description of the provider specialty
  • Procedure Code: A code used to describe a service rendered to the beneficiary
  • MAC Services: MAC allowed services as indicated in the Part B National Summary Data file
  • Specialty Percentage of Use in Each Region: Total allowed services for the specified procedure code and specialty for the contractor (i.e., S.C., N.C., Va., and W.Va.) divided by the total allowed services for the E/M code family and specialty for the contractor expressed as a percentage. Computation is based on allowed services for the contractor.
  • National Specialty Percentage of Use: Allowed services for the specified procedure code and specialty nationally divided by the total allowed services for the E/M code family (and any associated modifiers) and specialty nationally expressed as a percentage. Computation is based on allowed services for the nation.