G0180

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and

Code G0180. Medicare covered 921,546 of these. Here is what providers billed and what Medicare allowed, state by state.

$130.48Billed, national avg
$51.95Medicare allowed
2.5xBilled vs allowed
8.1xHighest vs lowest state

Providers in Foreign Country billed the most for this, at $516.42. In Guam the average was $63.50. 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
Foreign Country$516.42$52.489.8x42
Wisconsin$245.35$48.765.0x11,375
New Hampshire$220.16$52.674.2x5,338
Wyoming$210.23$51.414.1x179
District of Columbia$203.16$58.533.5x881
New York$178.68$57.553.1x39,072
Massachusetts$174.82$55.303.2x33,561
Alaska$173.47$57.353.0x298
North Dakota$164.36$49.943.3x1,443
Minnesota$161.44$49.753.2x15,100
Hawaii$157.15$56.582.8x105
Washington$154.30$52.762.9x13,665
Oregon$152.84$51.483.0x2,524
Rhode Island$152.23$54.042.8x1,645
Vermont$151.59$50.183.0x2,058
Connecticut$147.07$55.812.6x14,380
Maine$142.57$49.912.9x1,725
Maryland$142.13$54.562.6x16,364
Ohio$140.49$49.072.9x35,042
Kansas$138.61$46.953.0x6,556
New Jersey$137.91$57.302.4x17,106
Iowa$135.77$47.702.8x4,272
Pennsylvania$134.86$51.212.6x33,618
South Carolina$134.68$48.832.8x18,566
Illinois$134.13$53.542.5x52,794
Georgia$133.71$50.842.6x18,095
North Carolina$133.14$48.192.8x24,751
Utah$128.30$48.632.6x4,752
New Mexico$126.08$48.482.6x1,787
Montana$125.31$51.532.4x771
Idaho$125.08$47.602.6x2,892
Louisiana$124.62$48.572.6x17,216
South Dakota$123.25$50.182.5x1,214
Colorado$122.90$52.192.4x7,484
Puerto Rico$122.04$52.542.3x80
Kentucky$121.91$48.562.5x10,989
Missouri$121.77$50.122.4x8,013
Tennessee$120.20$47.682.5x24,581
Delaware$119.43$51.312.3x2,909
California$118.60$57.222.1x128,299
Michigan$118.23$50.832.3x27,601
Nebraska$117.96$48.802.4x2,004
Virginia$117.07$51.382.3x23,864
Florida$116.95$51.022.3x133,832
Oklahoma$116.74$47.942.4x16,260
Nevada$115.69$47.722.4x10,116
Texas$115.43$50.492.3x63,894
West Virginia$113.23$48.832.3x2,636
Indiana$107.44$48.012.2x10,566
Arizona$106.00$49.872.1x12,883
Mississippi$104.04$46.892.2x12,373
Arkansas$103.63$47.072.2x6,326
Unknown$101.57$58.621.7x51
Alabama$92.13$47.481.9x17,418
Armed Forces Pacific$73.00$48.471.5x25
Guam$63.50$54.821.2x146

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

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