99349

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes

Code 99349. Medicare covered 3,651,486 of these. Here is what providers billed and what Medicare allowed, state by state.

$224.64Billed, national avg
$111.36Medicare allowed
2.0xBilled vs allowed
4.2xHighest vs lowest state

Providers in Armed Forces Europe billed the most for this, at $482.14. In Guam the average was $113.86. 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$482.14$102.004.7x35
Alaska$386.89$141.322.7x5,657
Armed Forces Pacific$384.36$140.892.7x154
Delaware$301.58$108.802.8x9,013
New Hampshire$282.84$109.192.6x8,750
Montana$279.44$102.622.7x4,596
Maine$268.04$111.712.4x3,998
Ohio$265.34$103.842.6x126,499
Kansas$264.47$101.712.6x32,945
Connecticut$255.30$114.872.2x29,242
Massachusetts$253.94$112.402.3x48,931
District of Columbia$253.25$124.712.0x7,355
Oregon$250.75$112.332.2x10,409
Vermont$250.62$114.802.2x454
New York$247.36$127.321.9x226,737
Colorado$246.92$109.002.3x65,128
Iowa$243.35$102.402.4x13,447
North Dakota$242.22$103.952.3x6,317
Wyoming$240.01$105.702.3x2,881
California$238.76$119.572.0x343,764
Wisconsin$238.69$105.302.3x36,956
Arkansas$238.04$102.972.3x14,550
Idaho$236.64$101.622.3x23,438
Georgia$236.17$108.272.2x54,541
Illinois$235.43$117.272.0x176,829
Louisiana$232.30$104.702.2x12,940
Texas$230.81$108.602.1x250,281
Virginia$229.96$110.102.1x130,093
Minnesota$228.51$106.922.1x67,461
New Mexico$226.33$105.962.1x5,293
Michigan$225.84$112.342.0x110,982
Arizona$223.81$107.532.1x97,309
Washington$222.39$112.742.0x42,473
South Dakota$222.19$104.102.1x3,849
New Jersey$220.42$118.771.9x145,877
Nebraska$219.39$100.772.2x12,272
Nevada$218.08$106.142.1x48,378
Rhode Island$217.65$112.521.9x3,755
Florida$216.44$111.691.9x565,360
Pennsylvania$213.82$112.681.9x120,189
Kentucky$213.29$102.762.1x32,474
Missouri$212.20$106.272.0x30,334
Maryland$209.18$116.151.8x90,657
West Virginia$208.47$110.751.9x7,350
Utah$208.42$103.622.0x26,983
Tennessee$208.34$103.112.0x74,079
Indiana$204.75$102.722.0x77,998
North Carolina$204.70$103.502.0x195,160
Hawaii$192.76$114.101.7x4,611
Oklahoma$185.11$104.271.8x40,158
Alabama$182.81$98.271.9x21,327
Mississippi$169.35$100.481.7x19,874
Virgin Islands$165.59$122.801.3x47
South Carolina$164.83$103.491.6x158,161
Unknown$143.30$108.251.3x47
Puerto Rico$118.84$116.111.0x2,390
Guam$113.86$106.671.1x652

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

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