99222

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes

Code 99222. Medicare covered 6,018,660 of these. Here is what providers billed and what Medicare allowed, state by state.

$368.00Billed, national avg
$126.03Medicare allowed
2.9xBilled vs allowed
3.2xHighest vs lowest state

Providers in Alaska billed the most for this, at $646.57. In Puerto Rico the average was $199.51. 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$646.57$162.734.0x6,435
Wisconsin$512.74$117.964.3x90,114
Minnesota$504.25$119.724.2x80,920
New York$490.43$138.723.5x456,442
Northern Mariana Islands$482.78$121.044.0x100
New Hampshire$472.18$123.393.8x29,324
Armed Forces Central/South America$469.47$124.593.8x62
Wyoming$444.49$122.993.6x6,475
Massachusetts$422.41$128.913.3x171,610
California$416.63$132.553.1x406,639
New Jersey$407.43$134.323.0x287,876
North Dakota$398.73$120.243.3x20,019
Oregon$396.81$124.693.2x34,955
Nevada$389.67$122.813.2x51,653
Vermont$386.88$121.493.2x9,205
Washington$385.56$126.983.0x64,333
North Carolina$384.66$119.293.2x133,995
Armed Forces Pacific$377.41$127.633.0x163
Georgia$373.77$122.323.1x146,040
Connecticut$372.73$132.372.8x78,698
Illinois$371.16$130.022.9x303,893
New Mexico$370.85$122.583.0x18,596
Colorado$369.89$124.423.0x43,645
Armed Forces Europe$367.82$128.302.9x199
Guam$367.73$129.432.8x1,011
Arizona$366.16$122.673.0x107,732
Iowa$365.29$117.053.1x56,627
Montana$361.52$123.472.9x15,665
Florida$360.07$128.222.8x596,519
Delaware$354.21$122.992.9x36,160
Foreign Country$353.94$125.302.8x245
Tennessee$352.79$116.803.0x117,802
Maryland$349.62$128.512.7x113,436
District of Columbia$349.20$135.392.6x17,343
Texas$348.92$123.692.8x418,980
Rhode Island$346.42$126.822.7x17,733
Maine$345.69$122.862.8x19,068
Ohio$343.88$120.752.8x253,260
Idaho$337.47$117.812.9x15,307
Nebraska$337.23$116.392.9x38,059
Kansas$331.60$116.462.8x61,340
Hawaii$330.90$125.302.6x8,067
Virginia$329.97$124.512.7x151,761
South Dakota$328.88$118.682.8x19,827
South Carolina$326.65$120.062.7x88,859
Missouri$323.82$121.972.7x151,535
Pennsylvania$318.40$124.782.6x369,703
West Virginia$310.87$122.882.5x50,895
Kentucky$304.48$120.962.5x105,829
Oklahoma$304.43$119.202.6x62,693
Utah$295.94$120.112.5x24,807
Michigan$294.53$127.362.3x251,955
Louisiana$293.73$120.142.4x75,530
Mississippi$292.70$117.782.5x50,033
Indiana$283.00$117.442.4x135,472
Alabama$267.31$116.912.3x79,383
Arkansas$259.83$116.312.2x58,699
Virgin Islands$205.44$122.291.7x316
Puerto Rico$199.51$125.481.6x5,548

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

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