2. The average gross charges for orthopedic cases are $8,026. The average case revenue is $2,453.
3. Surgery centers in the Midwest received the highest average net revenue per orthopedics case with $2,739. Average net revenue was lowest in the Southeast at $2,111 per case.
4. Here are the average net revenues per orthopedics case by the number of operating rooms in the surgery center:
- 1-2 ORs — $2,111
- 3-4 ORs — $2,482
- More than 4 ORs — $2,383
5. Here are the average net revenues per orthopedics case by a surgery center’s total annual case volume:
- Less than 3,000 cases — $2,688
- 3,000-5,999 cases — $2,561
- More than 5,999 cases — $2,228
6. Here are the average net revenues per orthopedics case by a surgery center’s total net revenue:
- Less than $4.5 million — $1,958
- $4.5-$7.0 million — $2,354
- More than $7.0 million — $2,545
Medicare charges and payments
Here is the average 2008 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient) and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for 14 orthopedic procedures commonly performed in ASCs.
CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
7. Obtaining small amount of bone for graft (CPT 20900):
- average sub charge: $2,378
- average allow charge: $464
- average payment: $365
8. Open surgical partial removal of collar bone (CPT 23120):
- average sub charge: $4,052
- average allow charge: $511
- average payment: $400
9. Partial repair or removal of shoulder bone (CPT 23130):
- average sub charge: $4,307
- average allow charge: $747
- average payment: $590
11. Open repair of rotator cuff, recent (CPT 23410):
- average sub charge: $5,556
- average allow charge: $950
- average payment: $748
12. Open repair of rotator cuff, old (CPT 23412):
- average sub charge: $6,078
- average allow charge: $1,171
- average payment: $924
13. Reconstruction rotator cuff, old (CPT 23420):
- average sub charge: $6,301
- average allow charge: $1,165
- average payment: $925
14. Open repair elbow fracture involving ulnar bone (CPT 24685):
- average sub charge: $4,578
- average allow charge: $799
- average payment: $633
15. Wrist fracture pinning through skin (CPT 25606):
- average sub charge: $3,168
- average allow charge: $637
- average payment: $504
16. Open surgical treatment wrist fracture (radius) (CPT 25607):
- average sub charge: $5,405
- average allow charge: $1,142
- average payment: $900
17. Shoulder scope, repair cartilage tear (CPT 29807):
- average sub charge: $4,803
- average allow charge: $674
- average payment: $531
18. Shoulder scope, partial removal collar bone (CPT 29824):
- average sub charge: $4,408
- average allow charge: $439
- average payment: $346
19. Shoulder scope, bone shaving (CPT 29826):
- average sub charge: $5,207
- average allow charge: $679
- average payment: $535
20. Shoulder scope, rotator cuff repair (CPT 29827):
- average sub charge: $5,906
- average allow charge: $991
- average payment: $781
Sources:
Items 1-6: VMG Health’s 2009 Intellimarker
Items 7-20: CMS
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