What CMS pays for 15 spine procedures at ASCs vs. HOPDs

Alan Condon -   Print  |
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CMS' procedure price look-up tool allows users to compare average pay for several procedures in ASCs and hospital outpatient departments.

The tool shows national averages for the amount Medicare pays an ASC or hospital, as well as the national average copayment a patient without Medicare supplemental insurance owes in each setting.

Here's what 15 spine procedures cost at ASCs and hospital outpatient departments:

1. Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling (63685)

ASC
Total cost: $24,266
Medicare pays: $19,413
Patient pays: $4,852

HOPD
Total cost: $29,816
Medicare pays: $28,258
Patient pays: $1,558

2. Insertion of stabilizing or separating device into lower spine at single level with open decompression (22867)

ASC
Total cost: $13,265
Medicare pays: $10,612
Patient pays: $2,653

HOPD
Total cost: $16,966
Medicare pays: $15,354
Patient pays: $1,612

3. Insertion of artificial upper spine disc, anterior approach (22856)

ASC
Total cost: $13,515
Medicare pays: $10,812
Patient pays: $2,702

HOPD
Total cost: $17,655
Medicare pays: $15,905
Patient pays: $1,749

4. Insertion of stabilizing or separating device into lower spine at single level (22869)

ASC
Total cost: $10,337
Medicare pays: $8,270
Patient pays: $2,066

HOPD
Total cost: $12,363
Medicare pays: $10,863
Patient pays: $1,500

5. Fusion of lower spine bones, posterior or posterolateral approach (22612)

ASC
Total cost: $10,267
Medicare pays: $8,214
Patient pays: $2,053

HOPD
Total cost: $13,560
Medicare pays: $11,820
Patient pays: $1,740

6. Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 (22551)

ASC
Total cost: $10,201
Medicare pays: $8,160
Patient pays: $2,309

HOPD
Total cost: $13,682
Medicare pays: $11,917
Patient pays: $1,764

7. Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed (63664)

ASC
Total cost: $9,966
Medicare pays: $7,973
Patient pays: $1,992

HOPD
Total cost: $12,143
Medicare pays: $10,478
Patient pays: $1,665

8. Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 (22554)

ASC
Total cost: $9,738
Medicare pays: $7,789
Patient pays: $1,947

HOPD
Total cost: $13,211
Medicare pays: $11,540
Patient pays: $1,670

9. Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed (63663)

ASC
Total cost: $4,882
Medicare pays: $3,905
Patient pays: $975

HOPD
Total cost: $6,656
Medicare pays: $5,324
Patient pays: $1,330

10. Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace (63075)

ASC
Total cost: $4,336
Medicare pays: $3,461
Patient pays: $864

HOPD
Total cost: $7,661
Medicare pays: $6,129
Patient pays: $1,532

11. Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic (63003)

ASC
Total cost: $4,200
Medicare pays: $3,360
Patient pays: $839

HOPD
Total cost: $7,535
Medicare pays: $6,028
Patient pays: $1,507

12. Partial removal of upper spine bone with release of spinal cord and/or nerves (63045)

ASC
Total cost: $4,145
Medicare pays: $3,315
Patient pays: $828

HOPD
Total cost: $7,323
Medicare pays: $5,858
Patient pays: $1,464

13. Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar (63047)

ASC
Total cost: $3,954
Medicare pays: $3,163
Patient pays: $790

HOPD
Total cost: $7,132
Medicare pays: $5,706
Patient pays: $1,426

14. Partial removal of bone with release of spinal cord or spinal nerves of one interspace in lower spine (63030)

ASC
Total cost: $3,817
Medicare pays: $3,053
Patient pays: $762

HOPD
Total cost: $6,995
Medicare pays: $5,596
Patient pays: $1,398

15. Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar (62380)

ASC
Total cost: $2,929
Medicare pays: $2,343
Patient pays: $585

HOPD
Total cost: $6,264
Medicare pays: $5,011
Patient pays: $1,253

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