New York

What Medicare pays in New York

Billed charges against Medicare allowed amounts in New York, across the 248 procedures Medicare covers most often.

248Procedures
94,974,790Services covered
3.4xBilled vs allowed
#16Rank of 61

Providers here billed the most above the national figure for therapy procedure in a group setting. The average was $126.59 against a national $51.42. That is 2.5 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 New York

ProcedureBilled hereAllowedGapvs national billed
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$73.56$24.543.0x1.06x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$372.07$131.432.8x1.35x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$233.06$93.832.5x1.24x
Ground mileage, per statute mile$28.39$9.363.0x1.07x
Therapy procedure using functional activities$88.19$35.682.5x1.18x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$87.72$29.952.9x1.21x
Therapy procedure using manual technique, each 15 minutes$77.89$22.143.5x1.15x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$280.80$83.423.4x1.38x
Insertion of needle into vein for collection of blood sample$21.15$8.472.5x0.97x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$178.46$76.032.3x1.16x
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$56.35$17.293.3x1.30x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$415.60$125.283.3x1.28x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$250.44$107.252.3x1.19x
Pathology examination of tissue using a microscope, intermediate complexity$215.41$59.133.6x1.16x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$60.81$7.608.0x1.64x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$97.35$15.876.1x1.41x
Blood test, comprehensive group of blood chemicals$81.43$10.347.9x1.33x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$42.21$8.594.9x0.94x
Test for allergy using allergenic extract$14.78$4.363.4x1.12x
X-ray of chest, 1 view$49.67$9.785.1x0.95x
Destruction of precancer skin growth, 2-14 growths$37.79$6.815.6x1.72x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$584.71$176.363.3x1.43x
Therapy procedure for walking training, each 15 minutes$62.29$23.822.6x1.10x
Blood test, lipids (cholesterol and triglycerides)$119.53$13.099.1x1.24x
Psychotherapy, 45 minutes$180.23$92.062.0x1.02x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$571.57$180.953.2x1.40x
Established patient complete exam of visual system$276.80$135.282.0x1.22x
Blood test, thyroid stimulating hormone (tsh)$103.10$16.456.3x1.08x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$346.06$116.753.0x1.30x
Hemoglobin a1c level$63.49$9.506.7x1.09x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$143.89$58.302.5x1.22x
Administration of influenza virus vaccine$47.46$32.031.5x1.16x
Chiropractic manipulative treatment, 1-2 spinal regions$46.62$28.511.6x0.95x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$49.70$9.675.1x1.28x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$717.35$182.083.9x1.26x
Emergency department visit with high level of medical decision making$1,142.59$181.486.3x0.93x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$346.34$133.432.6x1.24x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$135.02$64.652.1x1.20x
Removal of fingernails or toenails, 6 or more nails$94.68$46.572.0x1.11x
Imaging of retina$152.28$43.693.5x1.23x

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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