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  • CMS pay for 10 orthopedic procedures at ASCs vs. HOPDs

    CMS pay for 10 orthopedic procedures at ASCs vs. HOPDs

    Alan Condon -  

    CMS' procedure price lookup tool enables users to compare average pay for several procedures in ASCs and hospital outpatient departments.

    The tool shows national averages for the amount Medicare pays an ASC or hospital, as well as the national average copayment a patient without Medicare supplemental insurance owes in each setting. Here's what 10 common orthopedic procedures cost at ASCs and hospital outpatient departments:

    Editorial note: This is not an exhaustive list. Prices include facility and physician fees.

    1. Repair of shoulder rotator cuff using an endoscope (29827)

    ASC
    Total cost: $3,918
    Medicare pays: $3,134
    Patient pays: $783

    HOPD
    Total cost: $7,096
    Medicare pays: $5,677
    Patient pays: $1,419

    2. Removal of bone cyst or growth of hip or pelvic bone with patient-derived bone graft (27067)

    ASC
    Total cost: $3,881
    Medicare pays: $3,104
    Patient pays: $775

    HOPD
    Total cost: $7,059
    Medicare pays: $5,647
    Patient pays: $1,411

    3. Removal or shaving of hip joint socket cartilage using an endoscope (29862)

    ASC
    Total cost: $3,649
    Medicare pays: $2,919
    Patient pays: $729

    HOPD
    Total cost: $6,827
    Medicare pays: $5,462
    Patient pays: $1,365

    4. Arthroscopy, knee, surgical; with meniscus repair (medial or lateral) (29882)

    ASC
    Total cost: $2,007
    Medicare pays: $1,605
    Patient pays: $401

    HOPD
    Total cost: $3,458
    Medicare pays: $2,765
    Patient pays: $691

    5. Incision to repair shoulder joint (23040)

    ASC
    Total cost: $2,033
    Medicare pays: $1,626
    Patient pays: $406

    HOPD
    Total cost: $3,484
    Medicare pays: $2,786
    Patient pays: $696

    6. Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture (29879)

    ASC
    Total cost: $1,974
    Medicare pays: $1,580
    Patient pays: $394

    HOPD
    Total cost: $3,425
    Medicare pays: $2,740
    Patient pays: $684

    7. Removal of tissue and/or bone at elbow with tendon repair, open procedure (24359)

    ASC
    Total cost: $1,974
    Medicare pays: $1,580
    Patient pays: $394

    HOPD
    Total cost: $3,425
    Medicare pays: $2,740
    Patient pays: $684

    8. Removal of both knee cartilages using an endoscope (29880)

    ASC
    Total cost: $1,870
    Medicare pays: $1,496
    Patient pays: $373

    HOPD
    Total cost: $3,321
    Medicare pays: $2,656
    Patient pays: $663

    9. Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial (29895)

    ASC
    Total cost: $1,769
    Medicare pays: $1,415
    Patient pays: $353

    HOPD
    Total cost: $3,220
    Medicare pays: $2,575
    Patient pays: $643

    10. Release and/or relocation of median nerve of hand (64721)

    ASC
    Total cost: $1,242
    Medicare pays: $994
    Patient pays: $248

    HOPD
    Total cost: $2,165
    Medicare pays: $1,732
    Patient pays: $432

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