99283

Emergency department visit with low level of medical decision making

Code 99283. Medicare covered 981,836 of these. Here is what providers billed and what Medicare allowed, state by state.

$408.98Billed, national avg
$66.92Medicare allowed
6.1xBilled vs allowed
6.5xHighest vs lowest state

Providers in Armed Forces Central/South America billed the most for this, at $757.67. In Puerto Rico the average was $117.38. 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$757.67$85.148.9x104
Alaska$643.65$85.047.6x3,706
Armed Forces Europe$628.11$66.899.4x115
Nevada$577.17$66.248.7x7,185
New Jersey$565.66$70.668.0x23,697
Florida$561.05$68.958.1x45,530
Louisiana$553.02$65.898.4x8,110
Texas$535.54$66.948.0x51,175
Arizona$535.00$64.688.3x23,194
Georgia$510.29$65.487.8x16,033
Wyoming$508.91$65.227.8x2,402
Tennessee$499.71$63.237.9x17,113
Armed Forces Pacific$499.25$71.727.0x91
Northern Mariana Islands$493.61$59.688.3x240
Wisconsin$454.68$63.257.2x20,733
Foreign Country$447.97$68.866.5x125
Ohio$435.13$65.666.6x42,437
South Carolina$432.65$65.196.6x26,481
Virginia$427.17$65.536.5x22,720
California$417.87$68.996.1x65,651
Washington$416.59$67.246.2x11,855
Connecticut$413.22$68.736.0x15,756
Oklahoma$410.17$64.806.3x24,797
Maryland$407.99$67.536.0x16,784
Hawaii$404.41$67.356.0x2,629
Illinois$399.57$69.775.7x43,448
Rhode Island$398.59$67.545.9x4,930
North Carolina$394.75$64.166.2x24,386
New York$392.54$72.225.4x74,190
New Mexico$385.70$66.975.8x9,192
Guam$385.56$69.745.5x419
Delaware$383.94$66.975.7x2,408
Michigan$381.81$68.515.6x35,602
Pennsylvania$377.87$67.325.6x50,916
Alabama$376.25$62.816.0x13,247
Colorado$367.67$67.285.5x14,595
Kentucky$359.05$64.935.5x16,513
Missouri$358.79$65.505.5x25,471
New Hampshire$353.84$65.825.4x5,409
Utah$347.01$67.025.2x5,639
North Dakota$342.19$65.085.3x3,095
Minnesota$340.77$63.655.4x18,639
Iowa$339.74$62.535.4x9,317
Arkansas$334.29$63.415.3x14,537
Oregon$332.17$66.645.0x13,459
Kansas$320.01$62.475.1x12,542
Mississippi$316.13$63.345.0x16,475
Massachusetts$313.22$67.764.6x31,987
South Dakota$312.30$63.224.9x3,588
Maine$310.33$65.284.8x9,187
Indiana$297.36$63.344.7x24,133
District of Columbia$282.11$71.034.0x4,257
Nebraska$277.34$61.424.5x10,568
Vermont$276.49$65.034.3x4,943
Idaho$267.75$63.404.2x4,252
West Virginia$257.01$66.943.8x12,496
Montana$239.15$67.343.6x6,828
Virgin Islands$238.51$64.573.7x339
Puerto Rico$117.38$67.431.7x6,056

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

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