99310

Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes

Code 99310. Medicare covered 2,232,111 of these. Here is what providers billed and what Medicare allowed, state by state.

$292.83Billed, national avg
$136.42Medicare allowed
2.1xBilled vs allowed
2.5xHighest vs lowest state

Providers in Alaska billed the most for this, at $413.17. In Guam the average was $167.89. 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$413.17$160.522.6x1,343
Minnesota$406.86$128.713.2x47,322
North Dakota$388.03$129.933.0x2,754
Georgia$387.61$130.973.0x34,051
Northern Mariana Islands$357.52$145.352.5x17
New York$350.32$147.332.4x68,722
Wyoming$340.51$132.952.6x3,045
Massachusetts$332.92$138.902.4x80,523
Utah$332.03$133.592.5x29,553
New Jersey$329.53$147.732.2x110,110
Wisconsin$329.36$127.552.6x34,745
Montana$328.80$138.682.4x5,613
Vermont$320.12$134.152.4x2,114
California$317.96$151.762.1x247,431
Washington$317.20$136.372.3x46,089
Oregon$314.62$131.412.4x14,509
Michigan$308.51$134.932.3x47,273
Delaware$307.05$133.022.3x8,812
Armed Forces Europe$304.74$133.772.3x19
Kansas$300.45$124.142.4x19,402
Tennessee$299.87$124.592.4x38,091
North Carolina$299.22$127.252.4x67,439
Nebraska$297.64$123.142.4x14,993
Puerto Rico$296.32$149.392.0x53
Florida$291.73$137.402.1x198,598
Texas$289.82$132.942.2x194,778
Maine$289.63$131.492.2x10,469
Colorado$287.49$138.792.1x53,347
Nevada$286.93$130.752.2x23,189
Idaho$282.91$127.672.2x9,549
District of Columbia$281.43$146.261.9x5,615
Armed Forces Pacific$280.85$128.322.2x253
Virginia$278.59$134.532.1x59,289
Illinois$276.53$137.682.0x112,415
Hawaii$276.28$149.881.8x7,736
Missouri$272.27$129.442.1x29,215
South Dakota$268.76$126.952.1x2,823
Maryland$263.79$142.921.8x69,925
New Mexico$261.67$130.092.0x22,324
New Hampshire$259.79$131.842.0x11,249
West Virginia$257.81$132.511.9x8,294
Ohio$255.65$129.172.0x39,227
Oklahoma$255.28$129.932.0x28,446
Arizona$254.90$134.841.9x47,776
Pennsylvania$254.13$134.681.9x125,475
Rhode Island$252.31$135.391.9x7,809
Unknown$249.28$136.001.8x59
Indiana$248.37$123.702.0x41,001
Alabama$245.23$125.192.0x14,635
Connecticut$243.90$136.661.8x36,648
Kentucky$239.81$126.051.9x16,886
Louisiana$239.33$128.211.9x27,221
Arkansas$228.74$122.311.9x8,828
Iowa$221.94$122.651.8x23,395
South Carolina$212.00$126.491.7x57,509
Mississippi$207.45$130.531.6x14,003
Guam$167.89$125.481.3x74

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

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