District of Columbia

What Medicare pays in District of Columbia

Billed charges against Medicare allowed amounts in District of Columbia, across the 229 procedures Medicare covers most often.

229Procedures
2,419,926Services covered
2.8xBilled vs allowed
#43Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $2,054.21 against a national $1,027.76. That is 2.0 times as much.

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.

The 40 most common procedures in District of Columbia

ProcedureBilled hereAllowedGapvs national billed
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$275.24$132.472.1x1.00x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$184.12$93.592.0x0.98x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$331.13$125.162.6x1.02x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$229.04$82.272.8x1.13x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$67.70$24.322.8x0.98x
Therapy procedure using functional activities$76.61$35.322.2x1.03x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$380.32$180.892.1x0.93x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$70.28$29.202.4x0.97x
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's$38.33$17.552.2x0.88x
X-ray of chest, 1 view$43.78$8.765.0x0.84x
Ground mileage, per statute mile$22.03$8.792.5x0.83x
Therapy procedure using manual technique, each 15 minutes$66.81$22.033.0x0.99x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$634.48$180.503.5x1.12x
Critical care, first 30-74 minutes$872.42$221.403.9x0.83x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$37.85$8.544.4x0.85x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$395.13$174.172.3x0.97x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$206.12$104.082.0x0.98x
Pathology examination of tissue using a microscope, intermediate complexity$144.51$41.383.5x0.78x
Destruction of precancer skin growth, 2-14 growths$17.51$7.102.5x0.80x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$61.36$15.583.9x0.89x
Emergency department visit with high level of medical decision making$957.05$180.645.3x0.78x
Screening mammography$280.18$83.173.4x1.13x
Screening 3d breast mammography$162.51$39.724.1x1.17x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$284.06$142.392.0x1.02x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$268.35$114.322.3x1.01x
Ct scan head or brain without contrast$199.01$42.864.6x0.81x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$570.38$143.554.0x1.20x
Hospital discharge day management, more than 30 minutes$382.41$118.773.2x1.08x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$156.04$74.162.1x1.01x
Psychotherapy, 1 hour$204.57$134.831.5x0.98x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$349.20$135.392.6x0.95x
Insertion of needle into vein for collection of blood sample$14.36$8.311.7x0.66x
Admn sarscov2 vacc 1 dose$70.71$42.791.7x1.40x
Emergency department visit with moderate level of medical decision making$586.21$121.994.8x0.74x
Administration of influenza virus vaccine$43.19$32.701.3x1.06x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$113.67$57.992.0x0.97x
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more$533.10$224.262.4x0.96x
X-ray of chest, 2 views$63.79$17.403.7x0.89x
Special stained specimen slides to examine tissue, each additional procedure$95.01$29.713.2x0.65x
Established patient complete exam of visual system$293.71$134.372.2x1.29x

The last column compares this state against the national average for the same code. Above 1.00 means providers here billed more.

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

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