To encourage healthcare transparency, Centers for Medicare and Medicaid Services has designed a new Medicare pricing tool website that allows patients to compare out-of-pocket costs for surgical and medical procedures at hospitals and freestanding surgery centers.
This is part of a Congress-mandated initiative called the 21st Century Cures Act.
“Can you imagine going to the grocery store, getting the groceries you need for the week, but never knowing the price of your items until a week later when the store sends you a bill? Sadly, that’s how healthcare works every day” – Seema Verma, Centers for Medicare and Medicaid Services Administrator (CMS Blog).
Medicare Pricing Tool
The Procedure Price Lookup Tool allows a qualified Medicare beneficiary to compare average payments and copayments for medical procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The website also provides the national average copayment a beneficiary with no Medicare supplemental insurance policy (Medigap) would pay the provider.
Colonoscopy, upper endoscopy and esophageal dilation are three of the most common GI outpatient procedures. Here are the average costs Medicare patients would pay for these procedures at a hospital outpatient department (HOPD) compared to an ambulatory surgery center (ASC).
|Most Common GI Procedures||
Average Cost Medicare Patient Pays at HOPD
|Average Cost Medicare Patient Pays at ASC||Average Savings at ASC|
|CPT code: 45380||$187||$98||$89|
|CPT code: 44360||$285||$125||$160|
|CPT code: 43248||$149||$77||$72|
What is an Ambulatory Surgery Center?
An ambulatory surgery center is a freestanding medical facility that offers preventive services and surgical care. Because of their convenience, efficiency and value, ASCs are attractive alternatives to hospital outpatient departments (HOPD). ASCs offer the same procedures, medical equipment and advanced technology as hospitals, and physicians often have privileges at both HOPDs and ASCs. This means you can receive the same procedure — performed by the same physician — and pay vastly different amounts depending on the facility you choose.
Benefits of Choosing an Ambulatory Surgery Center for Your Outpatient GI Procedure
ASCs can provide the high-quality procedures of a hospital at a reduced cost because there are fewer overhead costs like administrative staff, insurance, advertising and facility maintenance.
By choosing an ASC for your outpatient GI procedure, you can expect:
- Exceptional Value — On average, a procedure at an ASC will cost you 40 percent less than a hospital.
- Transparency — ASCs provide pricing information before your procedure, not after.
- Safe, Quality Procedures — Choose an ASC that is accredited by AAAHC and CMS – the industry leaders for quality and safety.
- Comfortable Environment — Pleasant, relaxed atmosphere with convenient parking.
- Personalized Care — Targeted, specialty services in a smaller setting.
- High Satisfaction Rate — Surveys reveal a 92 percent satisfaction rate among ASC patients.
Using the Medicare Website Procedure Price Lookup Tool
Using the Medicare pricing tool, you can quickly compare your out-of-pocket responsibility for hundreds of medical and surgical procedures at a surgery center vs. hospital. Follow these simple steps:
- Obtain the Current Procedural Terminology (CPT) code for your outpatient procedure. There are multiple variations for certain procedures, so ask your doctor or physician billing department for the specific CPT code.
- Go to www.medicare.gov/procedure-price-lookup/ and enter the CPT code in the box that says “search by procedure name or code.”
- Compare average costs.
- Under “Next Steps” you can access a checklist of questions to ask your doctor to determine what facility is best for your outpatient procedure.
- Search for ASCs in your area and make an appointment immediately by clicking here.
You have a right to know the price of your healthcare and your medical procedures. Talk to your physician about medical procedures you need to schedule this year and use the Medicare pricing tool to see how much you can save by using an ambulatory surgery center.