99306

Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more

Code 99306. Medicare covered 1,343,885 of these. Here is what providers billed and what Medicare allowed, state by state.

$353.87Billed, national avg
$173.69Medicare allowed
2.0xBilled vs allowed
2.4xHighest vs lowest state

Providers in Alaska billed the most for this, at $567.92. In Alabama the average was $236.85. 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$567.92$196.902.9x518
Northern Mariana Islands$454.24$170.622.7x13
Minnesota$453.38$165.952.7x12,395
Wisconsin$416.82$165.212.5x11,566
Montana$413.18$169.442.4x1,961
North Dakota$410.94$182.062.3x1,919
Nevada$407.51$161.922.5x16,685
Oregon$397.14$174.512.3x3,588
Washington$392.20$176.002.2x18,825
Georgia$392.01$169.192.3x23,689
Wyoming$387.66$172.882.2x841
South Dakota$386.60$171.212.3x1,252
Hawaii$381.94$180.642.1x2,414
New Hampshire$379.58$173.622.2x6,026
Puerto Rico$378.50$177.592.1x245
Massachusetts$374.64$178.032.1x49,777
Armed Forces Europe$373.32$157.702.4x13
Nebraska$371.96$152.582.4x3,997
Vermont$371.76$170.142.2x1,281
Michigan$370.32$175.032.1x31,156
Maine$369.91$169.702.2x4,360
Tennessee$369.75$161.412.3x15,769
Oklahoma$369.51$155.442.4x14,782
Kansas$369.05$162.742.3x8,833
New York$368.37$189.941.9x123,582
California$366.89$183.672.0x157,198
New Jersey$366.52$183.882.0x87,832
Florida$365.52$169.362.2x153,122
District of Columbia$363.52$183.022.0x3,260
Colorado$353.77$174.562.0x18,203
Texas$349.74$165.402.1x70,645
Illinois$344.86$171.732.0x69,051
Utah$342.62$163.332.1x6,512
New Mexico$341.30$164.312.1x6,035
North Carolina$338.39$164.052.1x37,286
Armed Forces Pacific$337.07$167.112.0x103
Idaho$337.06$162.842.1x5,713
Pennsylvania$336.45$172.402.0x72,042
Louisiana$336.19$164.152.0x7,370
Indiana$332.80$157.352.1x29,651
Kentucky$332.08$163.992.0x11,988
Ohio$329.50$167.612.0x36,373
Rhode Island$326.73$170.801.9x5,004
Virginia$325.59$174.041.9x37,583
Connecticut$325.05$178.911.8x22,709
Delaware$321.78$174.121.8x4,549
Iowa$321.77$159.712.0x5,603
West Virginia$319.26$169.741.9x4,753
Maryland$317.63$176.571.8x47,030
South Carolina$309.32$167.941.8x17,967
Missouri$302.09$166.521.8x18,155
Arizona$299.19$163.921.8x31,897
Arkansas$273.47$154.781.8x4,796
Mississippi$269.00$149.581.8x9,847
Unknown$263.19$155.511.7x54
Alabama$236.85$163.481.4x6,042

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

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