92012

Established patient problem focused exam of visual system

Code 92012. Medicare covered 3,155,982 of these. Here is what providers billed and what Medicare allowed, state by state.

$167.46Billed, national avg
$90.45Medicare allowed
1.9xBilled vs allowed
3.2xHighest vs lowest state

Providers in Minnesota billed the most for this, at $267.81. In Armed Forces Pacific the average was $85.00. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Minnesota$267.81$88.443.0x26,712
Massachusetts$226.54$92.852.4x97,983
Alaska$220.41$97.622.3x2,211
New York$210.34$97.872.1x380,163
District of Columbia$196.33$95.282.1x1,803
New Hampshire$194.57$88.692.2x13,155
Colorado$190.70$86.222.2x23,867
Vermont$189.65$86.182.2x4,346
Connecticut$188.78$94.042.0x64,860
New Jersey$182.95$97.301.9x204,236
California$177.21$99.771.8x505,759
Oregon$175.44$87.432.0x17,023
Wisconsin$173.94$79.102.2x11,966
North Dakota$171.89$83.872.0x3,656
Georgia$170.59$83.452.0x57,365
Nebraska$168.97$82.002.1x12,017
Iowa$166.33$80.822.1x21,653
Maryland$165.78$95.101.7x63,992
Foreign Country$165.16$83.672.0x305
Washington$162.74$94.151.7x32,376
Nevada$160.14$87.341.8x11,543
Northern Mariana Islands$159.96$94.871.7x801
Hawaii$159.02$93.821.7x25,595
Virgin Islands$158.74$87.161.8x764
Florida$158.25$87.191.8x277,999
Rhode Island$155.88$87.601.8x7,339
Pennsylvania$154.29$88.801.7x186,116
Illinois$152.10$86.511.8x115,153
New Mexico$151.66$80.921.9x11,174
Texas$149.61$85.541.7x278,043
South Carolina$147.93$83.421.8x46,734
Missouri$147.15$82.951.8x40,662
Ohio$147.14$79.931.8x41,736
Utah$146.60$78.571.9x14,894
Idaho$146.20$82.371.8x11,609
Guam$144.65$92.461.6x581
Arkansas$139.92$77.771.8x32,382
Kansas$138.34$80.781.7x33,751
Virginia$137.73$88.641.6x75,293
Delaware$134.80$87.361.5x11,564
Louisiana$134.45$79.841.7x63,307
Oklahoma$134.39$79.871.7x26,492
North Carolina$133.40$82.671.6x36,669
Arizona$131.59$85.561.5x44,967
Tennessee$127.93$80.391.6x39,969
Michigan$127.52$83.871.5x46,956
South Dakota$126.75$86.111.5x10,050
Maine$125.60$82.111.5x12,960
Montana$124.98$85.521.5x8,162
Mississippi$122.78$78.121.6x34,711
Kentucky$118.92$79.891.5x10,432
West Virginia$118.24$78.051.5x9,058
Alabama$117.63$79.561.5x14,375
Armed Forces Central/South America$117.27$82.321.4x110
Wyoming$115.35$87.031.3x1,642
Indiana$113.54$82.321.4x15,519
Puerto Rico$90.96$85.551.1x11,368
Armed Forces Pacific$85.00$81.591.0x23

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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