99232

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes

Code 99232. Medicare covered 34,684,276 of these. Here is what providers billed and what Medicare allowed, state by state.

$203.39Billed, national avg
$76.04Medicare allowed
2.7xBilled vs allowed
3.1xHighest vs lowest state

Providers in Armed Forces Central/South America billed the most for this, at $396.23. In Puerto Rico the average was $125.99. 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
Armed Forces Central/South America$396.23$75.435.3x332
Foreign Country$387.10$73.535.3x1,141
Alaska$376.17$98.743.8x52,549
Minnesota$284.62$72.413.9x326,382
New York$280.80$83.423.4x2,360,829
Wisconsin$270.56$71.343.8x442,780
Northern Mariana Islands$254.08$71.013.6x830
Vermont$246.07$73.153.4x40,284
Armed Forces Pacific$241.29$78.793.1x1,379
Oregon$240.44$75.463.2x174,194
New Hampshire$237.74$74.883.2x160,199
Massachusetts$234.89$77.893.0x794,432
Wyoming$233.35$73.533.2x34,191
Washington$232.34$77.203.0x361,578
District of Columbia$229.04$82.272.8x97,325
New Jersey$227.53$81.202.8x1,720,431
North Dakota$226.81$73.543.1x98,239
California$218.76$79.752.7x3,198,696
Colorado$216.04$75.192.9x261,729
Maryland$213.08$78.232.7x561,052
North Carolina$210.31$72.562.9x765,319
Utah$210.29$72.932.9x94,536
Georgia$209.33$74.322.8x893,422
Nevada$206.26$72.322.9x522,296
Rhode Island$206.09$76.892.7x85,806
Iowa$205.80$70.792.9x271,558
Montana$203.70$74.292.7x77,078
Kansas$202.62$71.092.9x305,302
Connecticut$201.68$79.162.5x337,180
Idaho$199.45$71.492.8x81,179
Tennessee$199.26$71.052.8x773,001
New Mexico$199.05$72.992.7x113,084
Virginia$198.38$75.502.6x789,798
Illinois$198.02$78.012.5x1,485,605
Maine$197.15$74.172.7x101,541
Ohio$196.34$72.542.7x1,201,702
West Virginia$193.91$74.712.6x250,192
Texas$192.19$74.472.6x3,025,684
Florida$192.08$77.012.5x3,787,969
Nebraska$188.19$71.092.6x203,397
Hawaii$187.98$76.392.5x53,912
South Carolina$186.08$73.232.5x562,467
Mississippi$181.18$70.462.6x334,584
Arizona$177.31$74.072.4x582,386
Missouri$176.32$73.472.4x773,546
Armed Forces Europe$176.02$68.792.6x1,161
South Dakota$175.85$72.392.4x90,468
Delaware$175.64$75.182.3x165,444
Pennsylvania$174.02$75.202.3x1,685,053
Guam$172.34$77.312.2x5,767
Unknown$170.17$76.652.2x99
Oklahoma$170.02$71.872.4x425,151
Kentucky$168.29$73.092.3x540,103
Michigan$162.41$76.802.1x1,243,408
Louisiana$162.28$72.532.2x567,526
Indiana$160.31$71.402.2x804,914
$160.00$79.312.0x77
Alabama$154.06$71.292.2x573,485
Arkansas$139.82$70.742.0x383,857
Virgin Islands$135.09$73.701.8x3,004
Puerto Rico$125.99$74.351.7x33,634

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

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