G0127

Trimming of dystrophic nails, any number

Code G0127. Medicare covered 1,190,124 of these. Here is what providers billed and what Medicare allowed, state by state.

$46.82Billed, national avg
$17.80Medicare allowed
2.6xBilled vs allowed
4.0xHighest vs lowest state

Providers in Alaska billed the most for this, at $106.31. In Wyoming the average was $26.51. 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$106.31$20.465.2x73
Rhode Island$68.10$17.124.0x14,759
Oklahoma$61.45$14.674.2x277
Minnesota$56.90$19.972.8x12,511
District of Columbia$54.33$20.342.7x3,147
Vermont$53.80$16.693.2x867
Louisiana$53.71$13.623.9x1,515
Wisconsin$53.47$19.162.8x25,043
New York$53.20$18.482.9x72,177
Iowa$52.99$18.602.8x5,731
New Jersey$52.18$18.252.9x56,253
New Hampshire$52.16$16.283.2x2,491
North Dakota$52.04$17.812.9x274
Virginia$51.89$16.983.1x31,791
Massachusetts$51.68$18.482.8x56,860
Connecticut$51.40$18.162.8x29,609
Texas$50.77$16.563.1x45,849
California$50.63$18.192.8x142,783
Missouri$50.57$15.543.3x18,577
Colorado$49.83$16.383.0x10,192
Nebraska$49.15$16.892.9x3,100
Mississippi$48.93$14.303.4x2,454
Delaware$48.42$17.902.7x2,664
Oregon$48.19$17.512.8x9,770
North Carolina$46.94$16.962.8x38,804
Idaho$46.41$18.112.6x3,740
Georgia$46.29$18.862.5x21,821
Maine$45.72$20.072.3x2,069
New Mexico$45.47$13.753.3x887
Indiana$45.43$17.972.5x23,492
Maryland$45.37$19.532.3x68,857
Utah$44.90$17.902.5x4,729
Montana$44.30$19.382.3x91
Illinois$44.10$16.932.6x136,892
Pennsylvania$43.68$18.002.4x87,588
Washington$42.87$21.712.0x7,409
Tennessee$41.34$17.572.4x11,738
Nevada$41.33$13.723.0x8,645
Arizona$41.25$17.932.3x18,842
Florida$40.92$16.602.5x95,354
Michigan$40.01$18.672.1x18,900
Arkansas$39.17$17.672.2x1,622
South Carolina$37.61$18.062.1x18,191
Virgin Islands$35.99$23.281.5x31
Ohio$35.30$18.101.9x42,771
South Dakota$35.12$18.121.9x1,260
Hawaii$34.44$20.701.7x272
Alabama$32.47$17.661.8x4,883
Kansas$29.20$16.351.8x5,686
Kentucky$29.11$17.731.6x14,305
West Virginia$27.63$18.591.5x1,266
Wyoming$26.51$19.501.4x1,174

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

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