Medicare payments for 5 orthopedic procedures in ASCs vs. HOPDs — Knee, shoulder & spine procedures have $1K+ difference

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.

Advertisement

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

More articles on orthopedics:
Total knee replacement hospitalization costs drop $616-$775 per case with Exparel as opioid use decreases
Intervention reduces postoperative opioid use for THA patients, but not TKA, study finds
TKR surgeries expected to grow 673% to 3.5M procedures in 2030 & 3 more stats

Advertisement

Next Up in Orthopedic

Advertisement

Comments are closed.