CMS released the Procedure Price Lookup tool, which provides the average payment to ASCs and HOPDs for select procedures. The data also shows the average patient copays without Medicare supplemental insurance.
Here are the comparisons for five orthopedic and spine procedures:
1. Knee arthroscopy with meniscus repair (CPT 29882):
• Medicare pays ASCs: $1,024
• Medicare pays HOPDs: $2,116
• Copay at ASCs: $256
• Copay at HOPDs: $529
2. Shoulder rotator cuff repair with endoscope (CPT 29827):
• Medicare pays ASCs: $2,177
• Medicare pays HOPDs: $4,485
• Copay at ASCs: $544
• Copay at HOPDs: $1,121
3. Spinal arthrodesis including discectomy (CPT 22551):
• Medicare pays ASCs: $5,870
• Medicare pays HOPDs: $8,783
• Copay at ASCs: $1,467
• Copay at HOPDs: $1,340
4. Laminectomy, facetectomy and foraminotomy (CPT 63047):
• Medicare pays ASCs: $2,177
• Medicare pays HOPDs: $4,485
• Copay at ASCs: $544
• Copay at HOPDs: $1,121
5. Hip socket reconstruction and repair of the thigh bone with an endoscope (CPT 29914):
• Medicare pays ASCs: $2,177
• Medicare pays HOPDs: $4,485
• Copay at ASCs: $544
• Copay at HOPDs: $1,121