99350

Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes

Code 99350. Medicare covered 1,299,284 of these. Here is what providers billed and what Medicare allowed, state by state.

$331.49Billed, national avg
$162.44Medicare allowed
2.0xBilled vs allowed
3.5xHighest vs lowest state

Providers in Alaska billed the most for this, at $578.09. In Guam the average was $167.13. 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$578.09$198.832.9x487
Armed Forces Pacific$559.14$206.052.7x31
Wyoming$470.14$155.523.0x503
Ohio$455.08$151.713.0x18,460
District of Columbia$451.85$184.212.5x2,197
Delaware$428.21$145.802.9x3,367
Wisconsin$413.40$152.182.7x16,027
Montana$412.27$146.112.8x2,925
Georgia$406.82$156.762.6x26,955
Minnesota$403.76$152.412.6x22,115
New York$388.63$181.352.1x48,990
New Jersey$388.42$165.602.3x52,854
Kansas$380.84$148.792.6x4,348
Massachusetts$375.98$162.422.3x23,697
Oklahoma$374.92$153.812.4x12,941
Vermont$368.01$166.922.2x354
Connecticut$359.98$173.202.1x7,177
Maine$353.79$161.072.2x2,664
New Mexico$353.69$163.902.2x2,432
California$348.98$178.832.0x189,786
Louisiana$343.37$149.282.3x8,028
South Dakota$342.28$148.612.3x943
North Dakota$339.68$149.842.3x3,377
Virginia$338.54$160.552.1x24,841
Iowa$338.24$146.962.3x2,474
Oregon$338.05$163.322.1x4,261
Maryland$336.77$167.782.0x41,851
Hawaii$335.14$153.382.2x2,553
Texas$326.40$158.082.1x160,176
Michigan$312.73$163.391.9x27,099
Florida$312.18$160.651.9x220,308
Pennsylvania$311.97$162.661.9x35,941
Idaho$311.62$151.822.1x8,171
New Hampshire$310.83$160.791.9x4,538
Colorado$308.64$157.522.0x16,922
Nevada$307.72$153.322.0x30,865
Washington$306.45$162.991.9x7,931
Illinois$304.88$168.881.8x49,462
Rhode Island$300.63$167.701.8x1,724
North Carolina$291.83$150.371.9x43,606
Arizona$291.32$156.081.9x36,937
South Carolina$287.88$155.411.9x22,648
Utah$287.25$151.101.9x13,461
Indiana$285.49$148.031.9x14,433
Missouri$283.96$157.011.8x6,784
Arkansas$281.07$150.161.9x7,959
Tennessee$278.72$150.651.9x29,381
Kentucky$271.47$149.611.8x7,086
West Virginia$264.89$162.371.6x2,432
Alabama$237.71$144.261.6x6,024
Mississippi$237.01$145.141.6x8,574
Nebraska$215.49$163.011.3x9,284
Unknown$199.32$154.881.3x228
Virgin Islands$186.41$175.991.1x289
Puerto Rico$182.31$179.091.0x296
Guam$167.13$157.611.1x38

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

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