99439

Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month

Code 99439. Medicare covered 3,107,166 of these. Here is what providers billed and what Medicare allowed, state by state.

$96.88Billed, national avg
$45.98Medicare allowed
2.1xBilled vs allowed
3.1xHighest vs lowest state

Providers in Wyoming billed the most for this, at $166.36. In Puerto Rico the average was $54.45. 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
Wyoming$166.36$43.263.8x3,720
Maryland$127.15$46.572.7x57,227
Alaska$125.14$57.332.2x2,797
Nevada$117.90$46.132.6x64,406
California$116.80$50.572.3x319,835
New York$113.94$48.372.4x209,754
Wisconsin$112.98$42.892.6x9,318
Oregon$111.40$46.452.4x12,972
Vermont$109.94$45.412.4x276
Connecticut$108.43$48.262.2x412,351
South Dakota$106.29$42.262.5x1,280
New Jersey$102.68$51.072.0x84,621
Massachusetts$100.29$47.972.1x33,420
Indiana$100.04$42.632.3x61,465
Iowa$98.29$42.862.3x19,953
Kansas$96.93$43.262.2x22,649
Illinois$95.91$45.962.1x74,616
Louisiana$95.32$42.902.2x46,792
Missouri$95.23$46.182.1x90,581
Rhode Island$94.74$43.822.2x8,010
Virginia$94.70$46.242.0x75,940
Colorado$92.72$45.282.0x41,832
Maine$91.84$43.782.1x3,030
Arkansas$91.09$42.472.1x27,817
Georgia$90.14$44.232.0x107,681
Tennessee$88.88$43.402.0x77,607
Idaho$88.70$39.602.2x14,499
Texas$88.62$45.362.0x240,166
Washington$88.58$45.142.0x20,503
Kentucky$85.93$43.322.0x50,925
Ohio$85.92$41.962.0x43,855
District of Columbia$85.32$48.651.8x5,458
Utah$84.73$41.832.0x8,008
Pennsylvania$84.70$43.781.9x110,322
Arizona$84.61$44.841.9x96,920
Florida$84.35$44.851.9x197,062
New Mexico$83.80$41.292.0x15,583
Minnesota$82.64$42.232.0x11,580
South Carolina$81.77$43.741.9x51,402
North Carolina$80.99$42.331.9x133,448
Michigan$80.92$45.131.8x61,295
Oklahoma$80.72$43.481.9x15,990
North Dakota$79.35$36.852.2x3,182
Nebraska$76.27$41.991.8x22,337
Delaware$75.76$46.381.6x17,898
Montana$74.34$42.321.8x1,289
West Virginia$73.72$38.081.9x15,581
Mississippi$73.70$42.711.7x33,561
Guam$70.89$50.471.4x709
New Hampshire$67.39$42.721.6x5,204
Alabama$65.26$43.741.5x57,584
Hawaii$59.01$47.151.3x2,428
Virgin Islands$57.06$47.121.2x204
Puerto Rico$54.45$41.131.3x192

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

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