Massachusetts

What Medicare pays in Massachusetts

Billed charges against Medicare allowed amounts in Massachusetts, across the 247 procedures Medicare covers most often.

247Procedures
39,767,898Services covered
3.5xBilled vs allowed
#10Rank of 61

Providers here billed the most above the national figure for therapy procedure in a group setting. The average was $116.68 against a national $51.42. That is 2.3 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 Massachusetts

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$55.59$8.876.3x2.10x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$363.99$119.053.1x1.32x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$253.63$85.793.0x1.35x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$67.67$23.962.8x0.98x
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$3.42$1.103.1x1.97x
Insertion of needle into vein for collection of blood sample$29.09$8.623.4x1.33x
Therapy procedure using functional activities$77.23$34.282.3x1.04x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$234.89$77.893.0x1.15x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$75.01$28.842.6x1.03x
Therapy procedure using manual technique, each 15 minutes$67.39$21.143.2x0.99x
Pathology examination of tissue using a microscope, intermediate complexity$195.69$51.223.8x1.05x
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$53.63$16.323.3x1.23x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$35.93$8.224.4x0.80x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$364.53$118.463.1x1.12x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$553.27$164.203.4x1.36x
Blood test, comprehensive group of blood chemicals$77.95$10.357.5x1.27x
Destruction of precancer skin growth, 2-14 growths$30.89$6.604.7x1.41x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$222.80$97.942.3x1.06x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$42.46$7.615.6x1.14x
Blood test, lipids (cholesterol and triglycerides)$126.20$13.119.6x1.31x
Administration of influenza virus vaccine$49.53$31.381.6x1.21x
Established patient complete exam of visual system$318.27$129.402.5x1.40x
Psychotherapy, 1 hour$206.41$123.411.7x0.99x
Admn sarscov2 vacc 1 dose$50.94$40.871.2x1.01x
Chiropractic manipulative treatment, 3-4 spinal regions$66.65$40.231.7x1.10x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$374.10$120.673.1x1.34x
Hemoglobin a1c level$59.72$9.516.3x1.03x
Psychotherapy, 45 minutes$175.42$84.432.1x0.99x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$510.73$159.433.2x1.25x
Blood test, thyroid stimulating hormone (tsh)$114.44$16.457.0x1.19x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$155.66$67.972.3x1.01x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$73.86$14.775.0x1.07x
X-ray of chest, 1 view$36.40$8.784.1x0.70x
Emergency department visit with high level of medical decision making$763.88$172.144.4x0.62x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$624.51$172.523.6x1.10x
Removal of cataract with insertion of prosthetic lens$740.09$228.903.2x0.72x
X-ray of chest, 2 views$52.02$14.003.7x0.72x
Imaging of retina$145.26$39.673.7x1.17x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$338.58$106.763.2x1.27x
Blood test, basic group of blood chemicals (calcium, total)$52.73$8.286.4x1.10x

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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