Requesting a comparative billing report -- Part B providers

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Home ► CBR ► Requesting a comparative billing report -- Part B providers

Last Modified: 1/16/2024 Location: FL, PR, USVI Business: Part B

Requesting a comparative billing report -- Part B providers

Comparative billing report (CBR) information is available to providers by SPOT or by written request. The purpose of the CBR is to show comparative data Medicare considers when determining how a provider’s billing patterns contrast with other providers in the same specialty. A CBR may be a helpful tool when conducting self-audits or preparing for a seminar or medical society meeting.

Types of comparative billing reports

Part B: Provider-specific reports (Available via SPOT only)

This type of CBR, best suited for individual physicians and non-physician practitioners, contains comparative information for all procedure codes billed. It is also available to specialties such as independent diagnostic testing facilities or clinical laboratories; however, due to the various types of services offered, the results will not be an “apples-to-apples” comparison. This type of CBR does not have value for physician groups.

Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow three to four months to permit claims to be finalized before a report can be generated. For example, January data is not available until April or May.

Evaluation and management distribution: Provider-specific (Available by written request only)

This type of CBR compares an evaluation and management (E&M) code family (example: CPT® codes 99211-99215) to the provider’s peer group (specialty) within the state/territory and the nation. The report is a bar graph distribution and depicts a provider’s percentage of allowed services per procedure code as compared to the state/territory and the nation. This CBR is useful to identify potential variances in coding within a code family.

Medicare updates the reports two times per year for the following dates of service:

• January through June

• July through December

Evaluation and management distribution: Service-specific (Available by written request only)

This CBR compares the state/territory’s utilization of E&M codes to the nation by specialty. This report is useful for medical society meetings to show variance within a code family between state’s/territories’ provider specialties and the nation.

The CMS Data Center updates the national data two times per year for the following dates of service:

• January through June

• July through December

Medicare must allow three to four months before a report can be generated. For example, the January through June timeframe is not available until September or October.

How to request a comparative billing report

Part B providers may request a provider-specific CBR through First Coast’s Secure Provider Online Tool (SPOT) or an E&M CBR through a written request.

Option 1 -- Request a CBR online through SPOT

To learn how to submit a CBR request using SPOT, view section 9 – Retrieve documents: Comparative Billing Report (CBR) -- Part B of the SPOT user guide

Note: Requests for CBRs through SPOT generally take between 30-60-minutes to process. Note: Requestors may log off SPOT while waiting for the report to be generated.

If you are not a registered SPOT user, view the benefits and learn how to setup a free account.

Option 2 -- Submit a written request for a CBR

To submit a written request for an E&M CBR, providers must follow these steps:

• A provider must request a CBR on office or corporate letterhead and the provider/officer signature must be affixed. A request from a corporate entity must be submitted by a corporate officer, or in the case of a hospital, the hospital administrator. If the requesting provider wants the information sent to another party, it must be noted in the letter.

• The request must include the following information: the type of CBR(s) desired, the individual provider number(s), and the dates of service preferred. Please beware that a CBR cannot be produced using the group Medicare number.

• The mailing address must be stated clearly and legibly in the letter, since these reports will only be sent via the U.S. mail and not electronically.

• The request must be faxed to Statistical and Medical Data Analysis at 904-361-0543 or mailed to:

First Coast Service Options
Statistical and Medical Data Analysis
PO Box 3411
Mechanicsburg, PA 17055-1825

Note: There is no fee for providing these reports.

Once Medicare receives a CBR request, the report and a CBR explanation document will be mailed to the requesting provider (or authorized party) within 10 business days.

Italicized and/or quoted material is excerpted from the American Medical Association Current Procedural Terminology. CPT codes, descriptions and other data only are copyrighted American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

Source: CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 11.1.6

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