99309

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes

Code 99309. Medicare covered 14,872,513 of these. Here is what providers billed and what Medicare allowed, state by state.

$210.73Billed, national avg
$96.78Medicare allowed
2.2xBilled vs allowed
2.3xHighest vs lowest state

Providers in Alaska billed the most for this, at $297.63. In Guam the average was $131.96. 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$297.63$114.642.6x6,251
Georgia$272.25$92.163.0x356,112
North Dakota$256.32$96.132.7x18,718
Northern Mariana Islands$253.66$101.862.5x208
New York$250.44$107.252.3x1,302,998
Minnesota$248.51$93.752.7x87,903
Nevada$246.55$93.642.6x132,246
Kansas$242.34$88.412.7x116,884
Wisconsin$238.76$91.352.6x96,259
Armed Forces Europe$236.50$94.032.5x959
Tennessee$228.07$86.902.6x317,987
Foreign Country$227.60$113.452.0x53
Vermont$225.28$92.922.4x8,816
Oregon$224.90$92.512.4x27,777
Massachusetts$222.80$97.942.3x492,476
Nebraska$222.33$88.132.5x40,076
Washington$220.42$96.362.3x142,298
Michigan$220.01$94.632.3x265,020
California$217.95$106.252.1x1,434,514
Hawaii$217.09$103.232.1x17,235
Montana$216.48$98.842.2x8,077
Unknown$216.03$98.892.2x621
Wyoming$214.76$96.352.2x9,453
Texas$214.04$93.382.3x1,015,099
Delaware$213.49$93.662.3x82,134
North Carolina$212.09$89.932.4x466,476
Florida$211.21$95.882.2x1,745,762
Puerto Rico$209.69$105.662.0x2,451
New Hampshire$208.15$94.222.2x62,389
New Jersey$207.08$105.482.0x793,073
Idaho$206.26$89.622.3x35,490
District of Columbia$206.12$104.082.0x36,187
Illinois$204.04$97.482.1x689,559
Colorado$202.58$96.222.1x174,003
Maryland$200.98$99.772.0x526,328
Missouri$198.63$91.972.2x232,224
Utah$198.54$92.722.1x76,119
Pennsylvania$197.89$96.572.0x747,356
Maine$196.64$92.112.1x39,766
Armed Forces Pacific$194.38$87.612.2x1,120
Alabama$193.88$88.252.2x131,593
Iowa$191.12$88.372.2x81,680
Virginia$190.10$93.662.0x460,023
Arizona$189.43$94.382.0x230,308
West Virginia$188.87$94.722.0x64,395
South Dakota$188.24$91.772.1x15,365
Indiana$186.33$87.812.1x408,853
Kentucky$185.85$89.512.1x202,719
New Mexico$185.57$89.172.1x53,766
Rhode Island$185.38$94.612.0x47,489
Connecticut$184.97$97.341.9x259,580
Ohio$179.04$90.192.0x537,575
Arkansas$178.63$86.972.1x83,430
Louisiana$177.13$89.282.0x229,567
Oklahoma$170.81$92.021.9x158,136
Mississippi$167.72$89.961.9x68,627
South Carolina$158.51$89.761.8x230,559
Guam$131.96$100.151.3x357

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

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