West Virginia

What Medicare pays in West Virginia

Billed charges against Medicare allowed amounts in West Virginia, across the 240 procedures Medicare covers most often.

240Procedures
6,528,603Services covered
2.8xBilled vs allowed
#46Rank of 61

Providers here billed the most above the national figure for manual urinalysis test with examination using microscope, automated. The average was $120.65 against a national $31.94. That is 3.8 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 West Virginia

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$17.44$9.611.8x0.66x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$223.34$102.612.2x0.81x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$160.32$72.942.2x0.85x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$54.09$20.862.6x0.78x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$193.91$74.712.6x0.95x
Therapy procedure using functional activities$59.17$27.892.1x0.79x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$58.23$24.922.3x0.80x
Therapy procedure using manual technique, each 15 minutes$56.44$18.883.0x0.83x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$46.27$7.805.9x1.03x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$319.85$112.362.8x0.98x
X-ray of chest, 1 view$40.49$8.105.0x0.77x
Destruction of precancer skin growth, 2-14 growths$22.12$5.054.4x1.01x
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$39.87$15.282.6x0.92x
Removal of cataract with insertion of prosthetic lens$258.57$83.593.1x0.25x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$188.87$94.722.0x0.90x
Pathology examination of tissue using a microscope, intermediate complexity$154.54$43.303.6x0.83x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$318.93$138.052.3x0.78x
Insertion of needle into vein for collection of blood sample$16.81$8.492.0x0.77x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$310.87$122.882.5x0.84x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$536.32$162.973.3x0.94x
Rotary wing air mileage, per statute mile$316.11$35.608.9x0.89x
Emergency department visit with high level of medical decision making$1,153.79$166.756.9x0.94x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$263.05$118.312.2x0.94x
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more$103.39$43.032.4x0.88x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$222.72$91.062.4x0.84x
Professional service for preparation and provision of 1 or more antigens$25.97$12.172.1x0.88x
Chiropractic manipulative treatment, 3-4 spinal regions$53.60$36.271.5x0.88x
X-ray of chest, 2 views$55.74$12.174.6x0.78x
Administration of influenza virus vaccine$38.47$26.261.5x0.94x
Ambulance service, basic life support, non-emergency transport, (bls)$650.33$234.722.8x0.58x
Established patient complete exam of visual system$180.52$113.421.6x0.79x
Emergency department visit with moderate level of medical decision making$556.71$114.604.9x0.71x
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care$37.86$8.194.6x0.97x
Imaging of retina$91.29$34.552.6x0.74x
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes$114.15$46.112.5x0.95x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$317.11$145.002.2x0.78x
Injection, bupivacaine liposome, 1 mg$6.19$1.404.4x1.27x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$140.99$64.332.2x0.91x
Hospital discharge day management, more than 30 minutes$301.73$108.052.8x0.85x
Test for allergy using allergenic extract$11.96$3.163.8x0.90x

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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