G0439

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Code G0439. Medicare covered 10,304,868 of these. Here is what providers billed and what Medicare allowed, state by state.

$278.53Billed, national avg
$117.90Medicare allowed
2.4xBilled vs allowed
3.4xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $453.11. In Northern Mariana Islands the average was $134.32. 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
Wisconsin$453.11$118.503.8x188,918
Minnesota$392.32$122.013.2x141,088
Alaska$388.84$151.482.6x11,824
Massachusetts$374.10$120.673.1x342,186
Armed Forces Europe$346.99$149.342.3x322
New York$346.34$133.432.6x559,641
Oregon$342.54$102.453.3x78,171
Washington$327.39$130.172.5x181,006
North Dakota$318.12$102.963.1x22,555
Connecticut$313.93$134.342.3x116,274
Foreign Country$306.38$105.432.9x70
New Hampshire$302.57$117.572.6x54,963
New Jersey$301.07$118.402.5x356,328
California$297.26$130.152.3x761,430
Georgia$290.07$121.062.4x315,493
Colorado$286.39$91.213.1x162,356
District of Columbia$284.06$142.392.0x21,173
Utah$281.07$119.912.3x91,414
Illinois$280.64$129.902.2x435,553
Rhode Island$276.85$97.962.8x38,443
Florida$276.19$121.072.3x856,046
Montana$274.81$90.713.0x46,245
Maryland$271.79$131.032.1x297,137
Iowa$266.16$115.192.3x124,798
Vermont$263.43$120.262.2x17,847
West Virginia$263.05$118.312.2x46,340
Maine$261.21$74.933.5x42,242
Arizona$260.66$120.502.2x253,680
Ohio$260.63$92.292.8x407,917
Nevada$258.28$121.362.1x61,246
Oklahoma$257.61$96.362.7x132,243
North Carolina$257.11$117.942.2x370,153
Kansas$256.68$94.442.7x112,933
Pennsylvania$254.77$111.852.3x483,194
Tennessee$252.65$112.542.2x275,860
South Carolina$250.44$119.732.1x247,860
Missouri$249.73$104.142.4x178,179
Virgin Islands$249.62$120.032.1x1,507
Virginia$249.53$123.062.0x372,690
Kentucky$249.15$107.702.3x143,670
Nebraska$248.96$91.902.7x86,556
Texas$247.45$122.142.0x653,537
Hawaii$246.87$111.392.2x22,763
Delaware$243.88$116.802.1x76,391
Indiana$234.63$116.772.0x220,618
Michigan$233.49$107.532.2x275,085
Wyoming$232.84$119.392.0x18,847
New Mexico$232.77$113.852.0x41,631
Idaho$224.55$114.502.0x43,815
Louisiana$224.11$116.281.9x110,654
Unknown$217.66$131.961.6x389
South Dakota$213.11$120.291.8x26,295
Armed Forces Pacific$210.35$115.391.8x483
Arkansas$205.34$94.472.2x120,617
Alabama$203.17$114.551.8x149,916
Puerto Rico$196.64$125.701.6x707
Mississippi$196.36$114.151.7x104,440
Guam$179.90$129.771.4x1,069
Northern Mariana Islands$134.32$130.011.0x52

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

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