99284

Emergency department visit with moderate level of medical decision making

Code 99284. Medicare covered 4,532,507 of these. Here is what providers billed and what Medicare allowed, state by state.

$787.96Billed, national avg
$114.81Medicare allowed
6.9xBilled vs allowed
3.0xHighest vs lowest state

Providers in American Samoa billed the most for this, at $1,370.00. In Vermont the average was $462.32. 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
American Samoa$1,370.00$93.3614.7x36
Louisiana$1,237.91$111.7411.1x68,672
Armed Forces Europe$1,225.94$111.8111.0x577
Armed Forces Central/South America$1,115.05$127.338.8x297
Texas$1,038.97$113.979.1x285,311
Foreign Country$998.72$114.858.7x519
Georgia$997.55$112.308.9x110,841
Nevada$995.19$113.568.8x34,394
Florida$990.95$118.128.4x292,076
Alaska$971.11$151.886.4x13,981
Tennessee$942.96$108.298.7x96,978
Arizona$931.08$111.438.4x89,948
Mississippi$907.83$110.148.2x60,632
New Jersey$897.90$121.247.4x116,658
Hawaii$853.76$113.787.5x13,643
Wyoming$837.19$110.467.6x7,110
Ohio$817.85$112.667.3x185,662
Alabama$816.94$107.197.6x65,328
New Mexico$808.81$114.437.1x30,604
Arkansas$793.93$108.747.3x59,980
Armed Forces Pacific$788.94$123.436.4x610
South Carolina$787.59$110.857.1x124,534
Oklahoma$778.67$110.617.0x79,243
Wisconsin$777.82$108.127.2x77,972
California$776.12$118.196.6x376,306
Northern Mariana Islands$770.08$101.577.6x96
Virginia$769.16$111.996.9x120,816
Washington$768.09$115.266.7x63,955
Michigan$761.27$117.196.5x181,657
Delaware$760.52$114.046.7x18,613
Maryland$760.24$116.646.5x93,512
North Carolina$753.14$108.946.9x136,027
Illinois$739.62$119.336.2x205,217
Kentucky$734.10$111.246.6x79,076
Connecticut$726.97$118.966.1x59,898
Rhode Island$714.07$116.116.2x18,968
New York$711.34$124.215.7x289,338
Colorado$709.99$114.946.2x59,319
Indiana$693.43$109.186.4x99,434
Kansas$687.08$107.236.4x45,346
Missouri$681.20$112.286.1x95,484
Utah$675.23$113.705.9x26,856
Guam$671.85$118.175.7x1,643
Virgin Islands$650.78$106.186.1x474
New Hampshire$632.33$112.765.6x24,210
Idaho$621.53$108.075.8x19,638
Puerto Rico$606.72$118.105.1x5,985
Pennsylvania$605.87$115.735.2x252,020
Minnesota$605.35$109.645.5x71,232
Oregon$605.06$113.875.3x47,977
Iowa$603.08$106.235.7x39,857
District of Columbia$586.21$121.994.8x17,250
Maine$580.34$112.935.1x26,616
West Virginia$556.71$114.604.9x39,441
Nebraska$551.37$105.455.2x29,845
South Dakota$547.84$108.415.1x10,179
North Dakota$534.54$111.844.8x10,037
Massachusetts$505.44$116.474.3x120,069
Montana$464.83$115.994.0x15,952
Vermont$462.32$110.974.2x14,445

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

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