G2212

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or

Code G2212. Medicare covered 959,448 of these. Here is what providers billed and what Medicare allowed, state by state.

$98.93Billed, national avg
$30.62Medicare allowed
3.2xBilled vs allowed
3.3xHighest vs lowest state

Providers in New Hampshire billed the most for this, at $151.56. In Virgin Islands the average was $45.73. 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
New Hampshire$151.56$29.775.1x5,669
Wisconsin$134.97$28.074.8x22,597
Alaska$124.90$38.503.2x2,496
New York$122.73$32.943.7x47,042
California$122.26$33.473.7x139,427
New Mexico$116.69$29.683.9x4,470
Illinois$112.56$31.693.6x37,865
Massachusetts$110.55$31.733.5x54,150
New Jersey$107.70$32.673.3x16,646
Montana$107.02$28.083.8x6,017
Texas$103.28$30.773.4x45,260
Minnesota$102.87$29.243.5x52,414
Guam$101.75$30.423.3x54
Arizona$101.52$29.543.4x25,990
Ohio$99.18$28.623.5x24,206
Iowa$96.84$27.053.6x10,074
Connecticut$96.19$31.433.1x12,078
Georgia$95.96$29.993.2x11,263
North Dakota$95.73$27.533.5x3,245
Washington$94.80$31.823.0x29,711
Florida$94.00$30.653.1x50,022
Oregon$92.48$29.733.1x14,867
Maine$92.13$29.223.2x5,297
Nevada$91.90$30.403.0x6,928
Colorado$89.37$29.863.0x24,088
Missouri$86.04$28.923.0x15,644
Nebraska$85.64$27.573.1x8,572
Tennessee$84.84$28.553.0x12,855
Maryland$84.49$31.942.6x35,691
Louisiana$84.40$28.882.9x7,248
Mississippi$82.92$28.023.0x2,374
Vermont$82.21$29.422.8x4,634
Kentucky$81.89$28.652.9x5,975
South Carolina$81.10$28.932.8x11,690
Pennsylvania$80.82$30.422.7x26,908
Wyoming$80.45$28.012.9x1,011
Indiana$79.96$28.112.8x12,971
North Carolina$78.92$28.912.7x35,046
Virginia$78.08$30.022.6x19,959
Foreign Country$78.00$28.742.7x108
Delaware$77.41$30.892.5x2,872
Hawaii$76.87$31.462.4x2,324
Rhode Island$75.77$30.852.5x1,306
District of Columbia$75.38$34.352.2x6,327
West Virginia$73.58$29.682.5x4,451
Kansas$73.42$28.252.6x20,234
Michigan$69.05$29.152.4x19,622
Utah$68.83$27.922.5x22,918
Alabama$66.86$29.022.3x3,960
Oklahoma$66.37$28.542.3x6,578
Idaho$61.67$27.162.3x9,305
Arkansas$60.34$27.242.2x3,738
South Dakota$60.28$27.922.2x3,133
Puerto Rico$59.10$33.761.8x20
Virgin Islands$45.73$30.481.5x47

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

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