93297

Evaluation of implantable heart and blood vessel monitoring system, remote up to 30 days

Code 93297. Medicare covered 839,353 of these. Here is what providers billed and what Medicare allowed, state by state.

$153.00Billed, national avg
$45.45Medicare allowed
3.4xBilled vs allowed
11.6xHighest vs lowest state

Providers in New York billed the most for this, at $299.88. In Puerto Rico the average was $25.75. 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
New York$299.88$47.346.3x155,900
Wisconsin$264.97$24.6110.8x2,888
Minnesota$250.46$39.216.4x8,947
Colorado$249.46$42.175.9x19,866
Alaska$227.19$59.713.8x3,311
Rhode Island$176.66$27.506.4x821
California$158.17$48.833.2x125,810
New Hampshire$157.43$32.484.8x2,001
Connecticut$146.30$52.082.8x3,982
Illinois$131.72$45.742.9x16,147
Tennessee$124.31$46.102.7x24,784
Texas$122.92$42.692.9x76,651
New Jersey$120.52$56.312.1x30,799
Georgia$114.88$46.032.5x13,694
Pennsylvania$114.78$54.662.1x22,023
Nebraska$110.94$47.782.3x6,734
Florida$110.49$48.782.3x65,724
Delaware$105.23$51.052.1x3,214
North Carolina$97.41$41.032.4x11,831
West Virginia$96.58$46.832.1x5,432
Maryland$95.56$46.982.0x14,109
Oregon$94.84$44.472.1x747
Missouri$94.66$45.052.1x11,005
Michigan$93.79$49.681.9x14,536
Massachusetts$91.16$47.111.9x11,693
Ohio$90.53$44.462.0x21,167
Kansas$89.62$41.852.1x10,875
Mississippi$89.33$38.122.3x6,008
Kentucky$88.22$48.741.8x6,493
Washington$82.74$36.942.2x2,124
Arizona$81.47$34.622.4x28,071
South Carolina$80.90$48.971.7x20,405
Indiana$79.18$46.201.7x13,061
District of Columbia$78.46$43.211.8x489
Iowa$77.92$30.142.6x4,776
Idaho$77.09$35.632.2x1,296
Louisiana$75.32$37.142.0x8,493
Nevada$73.65$28.842.6x6,383
Virginia$72.81$30.882.4x24,678
Utah$72.12$53.391.4x505
Alabama$69.40$40.851.7x7,777
Montana$68.29$41.901.6x1,713
Oklahoma$66.88$44.231.5x10,410
South Dakota$66.70$26.732.5x346
New Mexico$64.59$23.292.8x3,505
Arkansas$57.26$26.522.2x5,527
North Dakota$57.18$27.742.1x1,279
Wyoming$55.44$27.092.0x257
Vermont$42.62$29.561.4x1,017
Puerto Rico$25.75$25.341.0x15

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

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