See what CMS pays ASCs vs. HOPDs for 6 orthopedic procedures

Practice Management

A new CMS tool allows patients and providers to compare the average payment for various procedures in ambulatory surgery centers and hospital outpatient departments.

The Procedure Price Lookup Tool shows the national averages for the amount Medicare pays an ASC or hospital, as well as the national average copayment amount a patient without Medicare supplemental insurance owes in each setting.

Here are how six orthopedic procedure costs compare in HOPDs and ASCs:

1. Arthroplasty, knee, tibial plateau (27440)
ASC:
• Average Medicare pays: $5,835
• Average total cost: $7,294
• Amount patient pays on average: $1,459

HOPD:
• Average Medicare pays: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340

2. Arthroscopy, knee, surgical; with meniscus repair (29882)
ASC:
• Average Medicare pays: $1,024
• Average total cost: $1,280
• Amount patient pays on average: $256

HOPD:
• Average Medicare pays: $2,116
• Average total cost: $2,645
• Amount patient pays on average: $529

3. Insertion of artificial upper spine disc, anterior approach (22856)
ASC:
• Average Medicare pays: $8,970
• Average total cost: $11,213
• Amount patient pays on average: $2,243

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

4. Sacroiliac joint fusion (27279)
ASC:
• Average Medicare pays: $9,965
• Average total cost: $12,456
• Amount patient pays on average: $2,491

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

5. Anterior cervical discectomy (22551)
ASC:
• Average Medicare pays: $5,870
• Average total cost: $7,337
• Amount patient pays on average: $1,467

HOPD:
• Average Medicare pays: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340

6. Laminotomy foraminotomy decompression (63030)
ASC:
• Average Medicare pays: $2,177
• Average total cost: $2,721
• Amount patient pays on average: $544


HOPD:
• Average Medicare pays: $4,485
• Average total cost: $5,606
• Amount patient pays on average: $1,121

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