Texas

What Medicare pays in Texas

Billed charges against Medicare allowed amounts in Texas, across the 250 procedures Medicare covers most often.

250Procedures
106,964,379Services covered
3.4xBilled vs allowed
#14Rank of 61

Providers here billed the most above the national figure for removal of cataract with insertion of prosthetic lens. The average was $4,087.54 against a national $1,027.76. That is 4.0 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 Texas

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$25.58$9.282.8x0.97x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$267.36$116.862.3x0.97x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$185.02$82.472.2x0.98x
Detection test by nucleic acid for organism, amplified probe technique$56.79$34.361.7x0.90x
Insertion of needle into vein for collection of blood sample$21.66$8.522.5x0.99x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$192.19$74.472.6x0.94x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$65.57$21.753.0x0.95x
Blood test, comprehensive group of blood chemicals$64.30$10.336.2x1.05x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$36.84$7.594.9x0.99x
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$2.02$1.091.9x1.16x
Therapy procedure using functional activities$74.48$29.732.5x1.00x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$313.84$112.432.8x0.96x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$69.24$25.832.7x0.95x
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$38.15$15.582.4x0.88x
Blood test, lipids (cholesterol and triglycerides)$95.33$13.097.3x0.99x
Pathology examination of tissue using a microscope, intermediate complexity$224.93$51.664.4x1.21x
Blood test, thyroid stimulating hormone (tsh)$96.47$16.445.9x1.01x
Destruction of precancer skin growth, 2-14 growths$18.77$6.053.1x0.85x
Hemoglobin a1c level$62.15$9.506.5x1.07x
Therapy procedure using manual technique, each 15 minutes$62.85$19.773.2x0.93x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$214.04$93.382.3x1.02x
X-ray of chest, 1 view$78.54$8.489.3x1.50x
Detection test for candida species (yeast), amplified probe technique$54.36$34.371.6x0.90x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$391.58$155.032.5x0.96x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$48.37$7.836.2x1.08x
Test for allergy using allergenic extract$12.32$3.413.6x0.93x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$573.54$163.793.5x1.01x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report$59.73$13.564.4x0.87x
Professional service for preparation and provision of 1 or more antigens$29.65$13.682.2x1.01x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$152.15$64.822.3x0.99x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$379.83$161.222.4x0.93x
Established patient complete exam of visual system$226.85$121.351.9x1.00x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$247.45$122.142.0x0.89x
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$107.29$59.301.8x0.95x
Administration of influenza virus vaccine$35.41$28.011.3x0.87x
Manual urinalysis test with examination using microscope, automated$32.71$3.1010.5x1.02x
Chiropractic manipulative treatment, 3-4 spinal regions$59.45$37.521.6x0.98x
Injection of drug or substance under skin or into muscle$52.54$12.964.1x0.95x
Injection, bupivacaine liposome, 1 mg$7.55$1.385.5x1.55x
Emergency department visit with high level of medical decision making$1,525.29$168.259.1x1.24x

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