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

    CMS pay for 10 spine 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 spine procedures cost at ASCs and hospital outpatient departments:

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

    1. Insertion of stabilizing or separating device into lower spine at single level with open decompression (22867)

    ASC
    Total cost: $13,265
    Medicare pays: $10,612
    Patient pays: $2,653

    HOPD
    Total cost: $16,966
    Medicare pays: $15,354
    Patient pays: $1,612

    2. Insertion of artificial upper spine disc, anterior approach (22856)

    ASC
    Total cost: $13,515
    Medicare pays: $10,812
    Patient pays: $2,702

    HOPD
    Total cost: $17,655
    Medicare pays: $15,905
    Patient pays: $1,749

    3. Insertion of stabilizing or separating device into lower spine at single level (22869)

    ASC
    Total cost: $10,337
    Medicare pays: $8,270
    Patient pays: $2,066

    HOPD
    Total cost: $12,363
    Medicare pays: $10,863
    Patient pays: $1,500

    4. Fusion of lower spine bones, posterior or posterolateral approach (22612)

    ASC
    Total cost: $10,267
    Medicare pays: $8,214
    Patient pays: $2,053

    HOPD
    Total cost: $13,560
    Medicare pays: $11,820
    Patient pays: $1,740

    5. Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 (22551)

    ASC
    Total cost: $10,201
    Medicare pays: $8,160
    Patient pays: $2,309

    HOPD
    Total cost: $13,682
    Medicare pays: $11,917
    Patient pays: $1,764

    6. Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 (22554)

    ASC
    Total cost: $9,738
    Medicare pays: $7,789
    Patient pays: $1,947

    HOPD
    Total cost: $13,211
    Medicare pays: $11,540
    Patient pays: $1,670

    7. Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (63663)

    ASC
    Total cost: $4,882
    Medicare pays: $3,905
    Patient pays: $975

    HOPD
    Total cost: $6,656
    Medicare pays: $5,324
    Patient pays: $1,330

    8. Partial removal of upper spine bone with release of spinal cord and/or nerves (63045)

    ASC
    Total cost: $4,145
    Medicare pays: $3,315
    Patient pays: $828

    HOPD
    Total cost: $7,323
    Medicare pays: $5,858
    Patient pays: $1,464

    9. Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar (63047)

    ASC
    Total cost: $3,954
    Medicare pays: $3,163
    Patient pays: $790

    HOPD
    Total cost: $7,132
    Medicare pays: $5,706
    Patient pays: $1,426

    10. Partial removal of bone with release of spinal cord or spinal nerves of one interspace in lower spine (63030)

    ASC
    Total cost: $3,817
    Medicare pays: $3,053
    Patient pays: $762

    HOPD
    Total cost: $6,995
    Medicare pays: $5,596
    Patient pays: $1,398

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