99305

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes

Code 99305. Medicare covered 1,083,909 of these. Here is what providers billed and what Medicare allowed, state by state.

$290.31Billed, national avg
$126.19Medicare allowed
2.3xBilled vs allowed
3.7xHighest vs lowest state

Providers in Alaska billed the most for this, at $508.94. In Puerto Rico the average was $138.95. 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$508.94$160.093.2x475
Rhode Island$460.20$121.063.8x4,868
New York$360.71$135.372.7x143,544
Wisconsin$355.65$121.932.9x6,932
Minnesota$351.74$120.652.9x8,169
North Dakota$350.71$123.432.8x1,310
Nebraska$339.56$116.112.9x1,885
South Dakota$334.86$123.492.7x736
Delaware$334.81$124.122.7x5,736
Georgia$333.35$119.712.8x15,003
Nevada$331.24$117.052.8x6,831
Armed Forces Europe$323.48$115.382.8x265
Florida$315.24$125.532.5x127,401
Washington$313.99$125.712.5x12,246
Northern Mariana Islands$313.40$126.492.5x172
Wyoming$308.60$125.102.5x910
Kansas$307.17$116.202.6x8,460
Hawaii$302.72$131.752.3x1,067
Texas$300.70$120.732.5x52,186
Arizona$298.46$120.992.5x8,748
Oregon$291.81$125.472.3x3,033
Colorado$288.14$129.722.2x4,873
Massachusetts$279.08$129.662.2x27,903
Maryland$278.63$127.562.2x42,714
Vermont$278.31$120.562.3x980
Pennsylvania$278.21$122.062.3x51,474
New Jersey$278.04$131.452.1x82,383
Iowa$277.23$119.012.3x6,945
District of Columbia$276.41$131.992.1x1,359
Connecticut$275.11$129.682.1x15,922
Montana$275.10$128.032.1x1,209
Virginia$274.59$123.982.2x20,114
North Carolina$268.39$119.942.2x25,067
California$268.22$132.382.0x106,399
Michigan$267.60$124.902.1x32,366
New Mexico$263.57$115.192.3x1,685
New Hampshire$259.42$120.902.1x4,113
Tennessee$258.96$118.692.2x18,570
Illinois$258.11$124.332.1x75,876
Louisiana$254.62$117.602.2x6,491
West Virginia$253.12$121.932.1x6,040
Utah$246.65$121.742.0x2,861
Idaho$246.30$115.522.1x1,843
Ohio$244.68$121.592.0x35,988
Indiana$243.13$116.542.1x27,452
Maine$241.80$119.852.0x1,802
Missouri$241.58$119.652.0x15,474
Kentucky$241.36$121.422.0x13,388
Unknown$239.92$120.092.0x183
Mississippi$237.75$117.612.0x5,422
Oklahoma$233.86$117.412.0x12,492
Alabama$228.29$119.841.9x8,760
Arkansas$226.33$116.461.9x5,455
South Carolina$226.03$121.491.9x10,223
Puerto Rico$138.95$128.081.1x86

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

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