Montana

What Medicare pays in Montana

Billed charges against Medicare allowed amounts in Montana, across the 234 procedures Medicare covers most often.

234Procedures
4,437,573Services covered
2.7xBilled vs allowed
#54Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $2,026.32 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 Montana

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$23.87$10.082.4x0.90x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$231.45$102.252.3x0.84x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$57.77$23.122.5x0.84x
Therapy procedure using functional activities$68.00$29.802.3x0.91x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$165.20$76.342.2x0.88x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$62.84$26.742.4x0.87x
Therapy procedure using manual technique, each 15 minutes$55.30$20.362.7x0.82x
Injection, bupivacaine liposome, 1 mg$2.89$1.392.1x0.59x
Fixed wing air mileage, per statute mile$66.89$15.334.4x0.48x
Chiropractic manipulative treatment, 3-4 spinal regions$56.89$38.131.5x0.94x
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$33.77$15.402.2x0.78x
Destruction of precancer skin growth, 2-14 growths$19.84$5.893.4x0.90x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$203.70$74.292.7x1.00x
Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg$1.14$0.721.6x0.48x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$321.54$140.682.3x0.79x
Psychotherapy, 1 hour$184.13$115.481.6x0.88x
Insertion of needle into vein for collection of blood sample$16.09$8.581.9x0.74x
Pathology examination of tissue using a microscope, intermediate complexity$125.73$39.793.2x0.68x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$29.74$7.833.8x0.66x
Established patient complete exam of visual system$176.67$122.681.4x0.78x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$274.81$90.713.0x0.99x
Imaging of retina$98.30$39.222.5x0.79x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$348.25$112.863.1x1.07x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$342.12$146.872.3x0.84x
Administration of influenza virus vaccine$35.08$27.761.3x0.86x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$232.37$96.822.4x0.87x
Admn sarscov2 vacc 1 dose$49.28$35.381.4x0.98x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$104.47$47.872.2x0.89x
X-ray of chest, 1 view$35.13$8.234.3x0.67x
Emergency department visit with high level of medical decision making$683.51$169.614.0x0.55x
Destruction of precancer skin growth, 1 growth$147.82$50.432.9x0.95x
Chiropractic manipulative treatment, 1-2 spinal regions$45.51$26.471.7x0.93x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$634.77$165.063.8x1.12x
Blood test, comprehensive group of blood chemicals$64.12$10.336.2x1.04x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$37.56$7.594.9x1.01x
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function$273.26$82.833.3x0.58x
Screening mammography$144.20$50.022.9x0.58x
Removal of cataract with insertion of prosthetic lens$2,026.32$644.473.1x1.97x
Screening 3d breast mammography$95.96$30.183.2x0.69x
Hospital discharge day management, more than 30 minutes$372.13$108.563.4x1.05x

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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