93793

Anticoagulant management of patient taking warfarin

Code 93793. Medicare covered 1,282,550 of these. Here is what providers billed and what Medicare allowed, state by state.

$40.16Billed, national avg
$10.70Medicare allowed
3.8xBilled vs allowed
5.6xHighest vs lowest state

Providers in Alaska billed the most for this, at $96.51. In Vermont the average was $17.21. 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
Alaska$96.51$14.336.7x3,460
California$90.06$11.677.7x64,551
Wisconsin$67.04$10.356.5x68,698
Connecticut$59.58$11.225.3x8,501
Mississippi$55.57$10.095.5x12,959
Illinois$47.35$11.074.3x97,957
New Jersey$46.36$12.103.8x16,879
Minnesota$46.28$10.894.2x92,926
New York$44.62$11.144.0x62,765
Massachusetts$42.08$11.013.8x57,184
District of Columbia$40.97$11.803.5x751
Wyoming$40.54$11.103.7x6,348
Louisiana$39.13$10.503.7x19,955
Rhode Island$39.13$11.623.4x830
Texas$37.58$10.843.5x40,563
North Dakota$36.86$10.713.4x5,894
New Hampshire$36.74$10.533.5x14,302
Georgia$36.12$10.583.4x15,443
Oregon$35.54$10.443.4x22,047
North Carolina$34.43$10.493.3x40,400
Missouri$34.06$10.083.4x34,482
Iowa$33.68$10.063.3x23,483
Washington$33.31$11.013.0x13,235
South Dakota$32.91$10.293.2x925
Tennessee$32.58$10.163.2x23,402
Kentucky$32.22$9.883.3x23,324
Idaho$32.04$10.313.1x1,911
West Virginia$31.93$10.353.1x4,817
Indiana$31.15$9.803.2x30,035
Pennsylvania$31.00$10.473.0x113,480
Ohio$30.95$10.243.0x29,731
Nevada$29.94$10.602.8x6,546
Nebraska$29.84$10.442.9x9,847
Colorado$29.68$11.112.7x35,234
South Carolina$29.62$10.572.8x11,974
Michigan$29.56$10.862.7x17,532
New Mexico$29.55$10.432.8x3,402
Utah$28.51$9.483.0x17,782
Florida$28.38$11.032.6x71,741
Delaware$27.40$11.022.5x9,008
Oklahoma$26.43$10.462.5x5,965
Montana$26.12$10.732.4x1,266
Maryland$25.96$10.742.4x18,180
Arizona$25.94$10.802.4x27,153
Kansas$25.78$9.722.7x18,304
Virginia$25.56$10.842.4x40,249
Hawaii$24.68$10.162.4x221
Maine$21.79$10.352.1x4,430
Arkansas$21.54$9.712.2x15,860
Alabama$21.33$9.972.1x15,547
Vermont$17.21$9.931.7x890

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

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