CMS pay for 10 orthopedic procedures at ASCs vs. HOPDs

Alan Condon -   Print  |

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

More articles on orthopedics:
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14 key thoughts on bundled payments in spine surgery
Flexibility, patience & financial stability — 5 spine surgeons on lessons learned in 2020

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