99490

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month

Code 99490. Medicare covered 6,919,114 of these. Here is what providers billed and what Medicare allowed, state by state.

$112.91Billed, national avg
$59.57Medicare allowed
1.9xBilled vs allowed
2.4xHighest vs lowest state

Providers in Rhode Island billed the most for this, at $174.58. In Virgin Islands the average was $71.76. 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
Rhode Island$174.58$58.243.0x11,109
Alaska$165.67$75.232.2x2,888
South Dakota$143.35$59.542.4x7,640
Connecticut$139.35$62.972.2x453,421
Maryland$137.95$62.512.2x127,770
Maine$135.65$55.872.4x5,986
New York$135.02$64.652.1x554,588
Wyoming$134.06$56.132.4x7,863
Oregon$127.09$58.732.2x16,488
Wisconsin$123.15$57.352.1x23,107
District of Columbia$122.46$60.882.0x7,762
Nevada$121.78$59.552.0x73,839
California$121.07$65.001.9x677,314
Iowa$120.66$56.182.1x100,048
Ohio$120.32$55.452.2x98,764
Tennessee$120.26$56.672.1x144,078
New Jersey$120.00$66.271.8x200,581
Minnesota$119.87$56.122.1x26,224
Massachusetts$118.91$62.681.9x63,626
Missouri$117.48$59.122.0x132,112
North Dakota$116.74$48.562.4x4,906
Colorado$115.30$57.482.0x75,570
Illinois$114.57$61.141.9x191,563
Georgia$110.36$58.041.9x273,666
Washington$110.22$57.911.9x38,301
Louisiana$110.16$56.352.0x115,558
Kansas$109.03$52.782.1x72,336
Indiana$108.18$55.841.9x125,858
Texas$107.29$59.301.8x639,879
Arizona$106.70$57.631.9x234,474
Pennsylvania$106.64$57.291.9x187,561
Virginia$106.47$61.191.7x260,248
Florida$104.86$60.541.7x607,246
Utah$104.47$55.581.9x17,913
Michigan$102.47$59.391.7x126,903
North Carolina$101.51$55.291.8x215,774
Idaho$101.42$52.311.9x26,494
West Virginia$100.32$50.422.0x25,050
Puerto Rico$99.46$59.821.7x365
New Mexico$98.35$54.841.8x51,065
Mississippi$97.62$54.891.8x117,108
New Hampshire$97.40$53.281.8x9,777
Vermont$96.28$59.481.6x396
Nebraska$95.23$56.031.7x65,561
Montana$95.03$57.051.7x5,913
Delaware$94.57$59.621.6x57,206
South Carolina$92.97$57.701.6x172,002
Hawaii$88.37$62.201.4x4,932
Alabama$87.38$56.541.5x159,083
Arkansas$87.12$55.411.6x66,252
Oklahoma$82.21$57.181.4x83,255
Kentucky$79.88$39.802.0x150,132
Guam$76.98$65.261.2x1,161
Foreign Country$75.00$50.761.5x26
Virgin Islands$71.76$57.831.2x317

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

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