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  • Neurosurgeon accepted $3.3M in illegal payments to perform spine surgeries at hospital
  • Spine surgeon gets jail time for abusing patient during hospital visit
  • Providence to pay $22.7M to settle unnecessary spine surgery allegations
  • Texas spine surgeon defending himself from 'Dr. Death 2.0' allegations
  • 'They're on really thin ice': Why 1 insurer has drawn spine surgeons' ire
  • Orthopedic surgeon must face suit in patient's death
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  • Connecticut hospital to appeal $12.5M verdict to family of patient who died after orthopedic surgery
  • 4 spine technologies that promised more than they delivered
  • Orthopedic surgeon's health system exit steeped in controversy
  • Terminated orthopedic surgeon contracts with another New York hospital
  • Texas spine surgeon sued by State Farm over 'unnecessary' procedures
  • 22 hospitals ranked top 25 orthopedic hospitals 3+ years in a row
  • Orthopedic surgeon convicted of battery at hospital
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  • 'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons
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  • What CMS pays for 15 spine procedures at ASCs vs. HOPDs

    What CMS pays for 15 spine procedures at ASCs vs. HOPDs

    Alan Condon -  

    CMS' procedure price look-up tool allows 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 15 spine procedures cost at ASCs and hospital outpatient departments:

    1. Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling (63685)

    ASC
    Total cost: $24,266
    Medicare pays: $19,413
    Patient pays: $4,852

    HOPD
    Total cost: $29,816
    Medicare pays: $28,258
    Patient pays: $1,558

    2. 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

    3. 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

    4. 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

    5. 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

    6. 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

    7. Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (63664)

    ASC
    Total cost: $9,966
    Medicare pays: $7,973
    Patient pays: $1,992

    HOPD
    Total cost: $12,143
    Medicare pays: $10,478
    Patient pays: $1,665

    8. 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

    9. 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

    10. Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace (63075)

    ASC
    Total cost: $4,336
    Medicare pays: $3,461
    Patient pays: $864

    HOPD
    Total cost: $7,661
    Medicare pays: $6,129
    Patient pays: $1,532

    11. Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic (63003)

    ASC
    Total cost: $4,200
    Medicare pays: $3,360
    Patient pays: $839

    HOPD
    Total cost: $7,535
    Medicare pays: $6,028
    Patient pays: $1,507

    12. 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

    13. 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

    14. 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

    15. Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar (62380)

    ASC
    Total cost: $2,929
    Medicare pays: $2,343
    Patient pays: $585

    HOPD
    Total cost: $6,264
    Medicare pays: $5,011
    Patient pays: $1,253

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