97530

Therapy procedure using functional activities

Code 97530. Medicare covered 44,653,830 of these. Here is what providers billed and what Medicare allowed, state by state.

$74.55Billed, national avg
$31.54Medicare allowed
2.4xBilled vs allowed
2.4xHighest vs lowest state

Providers in Alaska billed the most for this, at $103.80. In Puerto Rico the average was $42.51. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$103.80$37.282.8x120,980
Armed Forces Pacific$103.24$30.933.3x1,360
New York$88.19$35.682.5x3,805,906
Minnesota$87.91$31.262.8x216,512
New Jersey$86.20$34.712.5x2,928,748
Michigan$86.16$30.952.8x883,873
Nevada$84.62$30.392.8x415,353
Wisconsin$84.28$30.212.8x386,606
North Dakota$83.88$30.152.8x87,609
Indiana$80.13$28.882.8x804,571
Illinois$79.48$31.372.5x2,181,388
Delaware$79.14$31.462.5x436,765
Armed Forces Central/South America$78.00$30.742.5x539
Oregon$77.90$30.692.5x562,374
New Hampshire$77.59$32.802.4x129,764
Rhode Island$77.57$33.202.3x192,357
Massachusetts$77.23$34.282.3x893,922
District of Columbia$76.61$35.322.2x76,126
Florida$76.15$29.722.6x2,919,140
Colorado$76.08$31.812.4x786,138
Arizona$75.87$30.172.5x1,570,397
Wyoming$75.82$30.952.5x190,618
Washington$74.71$31.682.4x1,239,593
Connecticut$74.61$34.282.2x383,579
Texas$74.48$29.732.5x2,140,981
Maryland$73.81$33.372.2x1,377,511
Virginia$73.45$31.292.3x1,444,363
Nebraska$73.05$28.892.5x460,756
Foreign Country$72.64$28.782.5x2,592
Kentucky$71.11$28.472.5x528,059
South Dakota$70.97$31.302.3x106,285
Oklahoma$70.74$28.352.5x549,472
Iowa$70.68$29.942.4x439,733
Maine$70.33$30.692.3x135,273
Armed Forces Europe$70.14$33.682.1x941
New Mexico$69.61$28.442.4x240,108
Pennsylvania$69.43$31.622.2x1,948,489
Missouri$68.78$29.022.4x698,910
Ohio$68.29$29.262.3x738,654
Montana$68.00$29.802.3x269,554
Louisiana$67.90$29.332.3x503,322
North Carolina$67.31$29.562.3x1,236,744
Georgia$67.16$30.032.2x1,066,405
Kansas$66.26$29.152.3x465,900
California$66.11$34.151.9x4,557,890
South Carolina$65.38$28.832.3x1,257,970
Mississippi$65.06$27.982.3x500,531
Tennessee$64.24$29.052.2x960,004
Arkansas$63.75$28.292.3x343,254
Alabama$63.41$28.942.2x529,585
Utah$62.58$29.832.1x279,191
Virgin Islands$61.95$31.592.0x6,906
Hawaii$61.67$32.321.9x112,892
Vermont$61.01$29.812.0x62,316
Idaho$60.56$29.162.1x277,979
West Virginia$59.17$27.892.1x191,583
Unknown$52.27$26.462.0x1,458
Guam$42.68$34.401.2x867
Puerto Rico$42.51$31.141.4x2,836

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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