Denial Risk

The chance that 20% or more of a group of HBOT claims is denied by Medicare.

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About the denial risk model

This calculator estimates whether a group of HBOT claims, defined by Medicare contractor, specialty, place of service, code and modifier, will have 20% or more of its services denied. It uses only what is known before Medicare decides.

The Medicare administrative contractor is the strongest driver: the share of heavily denied claim groups ranges from about 8% to 24% across jurisdictions. A setting comparison shows how the same claims would fare in hospital and office settings.

Predicts: Probability that 20% or more of a claim group's services are denied.
Inputs: Contractor, specialty, place of service, code (99183 or G0277), modifier, yearly volume, charge per service and, optionally, last year's denial rate.
Validation: Rolling origin: every year from 2015 to 2025 predicted only from earlier years, with grouped and random cross-validation as checks.
Data: Physician/Supplier Procedure Summary, all Medicare Part B HBOT claims, 2010 to 2025.

Research demonstration only. Not billing advice. Predictions are for groups of claims, not individual claims.