Kentucky

What Medicare pays in Kentucky

Billed charges against Medicare allowed amounts in Kentucky, across the 245 procedures Medicare covers most often.

245Procedures
18,038,953Services covered
2.9xBilled vs allowed
#42Rank of 61

Providers here billed the most above the national figure for detection test for candida species (yeast), amplified probe technique. The average was $92.37 against a national $60.27. That is 1.5 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 Kentucky

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$18.44$10.331.8x0.70x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$230.14$108.372.1x0.84x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$153.04$76.502.0x0.81x
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled$2.39$1.112.2x1.38x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$58.18$21.112.8x0.84x
Removal of cataract with insertion of prosthetic lens$194.04$46.104.2x0.19x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$168.29$73.092.3x0.83x
Therapy procedure using functional activities$71.11$28.472.5x0.95x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$64.78$24.672.6x0.89x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$281.86$110.922.5x0.87x
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$34.90$15.112.3x0.80x
Therapy procedure using manual technique, each 15 minutes$61.71$19.133.2x0.91x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$34.63$7.714.5x0.77x
Insertion of needle into vein for collection of blood sample$17.32$8.582.0x0.79x
Destruction of precancer skin growth, 2-14 growths$24.07$5.524.4x1.10x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$185.85$89.512.1x0.88x
Professional service for preparation and provision of 1 or more antigens$32.67$12.672.6x1.11x
Test for allergy using allergenic extract$10.50$3.163.3x0.79x
Pathology examination of tissue using a microscope, intermediate complexity$172.51$42.434.1x0.93x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$337.86$146.462.3x0.83x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$34.01$7.594.5x0.92x
X-ray of chest, 1 view$42.28$8.065.2x0.81x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$79.88$39.802.0x0.71x
Blood test, comprehensive group of blood chemicals$36.03$10.323.5x0.59x
Emergency department visit with high level of medical decision making$1,210.13$163.517.4x0.98x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$249.15$107.702.3x0.89x
Administration of influenza virus vaccine$42.47$25.861.6x1.04x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$513.18$160.713.2x0.90x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$135.45$62.442.2x0.88x
Rotary wing air mileage, per statute mile$388.23$39.759.8x1.09x
Chiropractic manipulative treatment, 3-4 spinal regions$56.18$36.291.5x0.93x
Hemoglobin a1c level$49.73$9.445.3x0.86x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$214.82$95.832.2x0.81x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$50.36$12.534.0x0.73x
Professional service for multiple injections of allergen$33.82$10.533.2x0.93x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$327.21$149.262.2x0.80x
Blood test, lipids (cholesterol and triglycerides)$65.92$13.065.0x0.69x
Injection of drug or substance under skin or into muscle$46.89$12.313.8x0.85x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$304.48$120.962.5x0.83x
Aspiration and/or injection of fluid from large joint$222.46$61.603.6x0.76x

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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