Tennessee

What Medicare pays in Tennessee

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

248Procedures
35,524,742Services covered
3.2xBilled vs allowed
#22Rank of 61

Providers here billed the most above the national figure for set-up portable x-ray equipment. The average was $77.22 against a national $50.82. 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 Tennessee

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$25.18$9.582.6x0.95x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$242.68$109.022.2x0.88x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$164.79$77.092.1x0.87x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$62.51$21.302.9x0.90x
Insertion of needle into vein for collection of blood sample$17.20$8.552.0x0.79x
Therapy procedure using functional activities$64.24$29.052.2x0.86x
Blood test, comprehensive group of blood chemicals$34.02$10.313.3x0.55x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$25.51$7.583.4x0.69x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$199.26$71.052.8x0.98x
Therapy procedure using manual technique, each 15 minutes$55.60$19.302.9x0.82x
Pathology examination of tissue using a microscope, intermediate complexity$176.17$49.073.6x0.95x
Blood test, lipids (cholesterol and triglycerides)$54.50$13.054.2x0.57x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$57.92$24.702.3x0.80x
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$47.89$14.793.2x1.10x
Destruction of precancer skin growth, 2-14 growths$15.39$5.562.8x0.70x
Blood test, thyroid stimulating hormone (tsh)$65.61$16.434.0x0.68x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$316.99$107.952.9x0.97x
Hemoglobin a1c level$41.11$9.454.3x0.71x
Removal of cataract with insertion of prosthetic lens$585.66$133.404.4x0.57x
X-ray of chest, 1 view$48.81$8.325.9x0.93x
Injection of drug or substance under skin or into muscle$47.96$12.203.9x0.87x
Professional service for preparation and provision of 1 or more antigens$26.49$12.702.1x0.90x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$37.24$7.534.9x0.83x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$228.07$86.902.6x1.08x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$367.96$145.292.5x0.90x
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$1.67$1.101.5x0.96x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$52.65$12.624.2x0.76x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$252.65$112.542.2x0.91x
Automated urinalysis test$11.39$2.185.2x0.75x
Chiropractic manipulative treatment, 3-4 spinal regions$54.46$36.271.5x0.90x
Administration of influenza virus vaccine$33.62$26.511.3x0.82x
Test for allergy using allergenic extract$12.03$3.004.0x0.91x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$349.42$151.762.3x0.86x
Injection, bupivacaine liposome, 1 mg$4.00$1.402.9x0.82x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$565.95$155.863.6x1.00x
Vitamin d-3 level$110.62$28.883.8x0.60x
Established patient complete exam of visual system$208.70$115.541.8x0.92x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$137.75$60.992.3x0.89x
Emergency department visit with high level of medical decision making$1,455.54$159.379.1x1.18x
Creatinine level to test for kidney function or muscle injury$26.98$5.045.4x0.59x

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.

← All states  ·  All procedures