99348

Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes

Code 99348. Medicare covered 1,831,073 of these. Here is what providers billed and what Medicare allowed, state by state.

$150.91Billed, national avg
$69.54Medicare allowed
2.2xBilled vs allowed
6.5xHighest vs lowest state

Providers in Armed Forces Europe billed the most for this, at $538.69. In Puerto Rico the average was $82.58. 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
Armed Forces Europe$538.69$62.658.6x84
Alaska$297.96$89.193.3x1,465
Armed Forces Pacific$228.75$84.742.7x30
District of Columbia$218.70$76.922.8x1,654
Montana$210.69$66.713.2x1,551
Washington$190.19$69.752.7x18,555
Colorado$187.08$65.432.9x28,611
Delaware$184.41$66.022.8x6,453
Oregon$180.45$67.482.7x4,086
Georgia$178.14$66.892.7x17,065
Utah$176.99$63.532.8x11,137
Rhode Island$172.66$67.192.6x1,842
Minnesota$171.23$64.292.7x15,748
Nebraska$170.48$62.232.7x3,218
Idaho$169.13$61.702.7x4,765
Connecticut$168.08$71.692.3x13,559
Wisconsin$166.81$64.422.6x15,904
West Virginia$165.90$64.252.6x2,254
Massachusetts$165.46$70.742.3x27,321
Maine$165.18$67.522.4x4,650
New Jersey$164.75$74.412.2x81,480
Kansas$163.78$62.182.6x15,397
Iowa$161.67$63.232.6x5,470
New Hampshire$158.60$68.422.3x8,034
Arizona$156.64$67.092.3x37,661
California$156.13$72.422.2x261,128
Nevada$155.20$65.342.4x23,638
Vermont$154.37$69.082.2x522
New Mexico$151.79$67.472.2x2,506
Texas$150.99$66.482.3x98,165
North Dakota$150.59$62.582.4x2,156
New York$150.37$79.641.9x148,967
Illinois$149.82$71.962.1x91,622
Virginia$148.06$67.232.2x62,137
Hawaii$147.62$66.952.2x1,676
Florida$147.60$69.712.1x312,814
Wyoming$147.50$65.102.3x1,514
Missouri$147.43$64.732.3x22,000
Ohio$145.16$65.132.2x78,881
North Carolina$144.29$63.172.3x47,353
Kentucky$144.04$62.632.3x13,853
Michigan$139.56$70.412.0x70,274
Maryland$138.75$70.652.0x51,101
Arkansas$138.04$61.362.2x8,988
Pennsylvania$137.88$69.702.0x59,272
South Dakota$136.78$63.342.2x1,973
Louisiana$136.29$64.902.1x6,047
Tennessee$133.43$62.582.1x32,889
Oklahoma$129.95$64.982.0x18,877
Indiana$127.62$62.542.0x35,135
South Carolina$127.12$65.122.0x26,241
Alabama$125.64$61.572.0x8,728
Mississippi$118.34$60.322.0x12,505
Guam$99.84$64.541.5x127
Puerto Rico$82.58$73.801.1x1,906

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

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