Medicare has released their new Procedure Price Lookup website to help Medicare beneficiaries estimate the cost of health care procedures. As Medicare indicates in their footnotes, the prices are national averages based on 2018 data. Prices and the cost-sharing amount for the beneficiary will vary by region. The prices are for outpatient health care services generally covered by Part B of Medicare. If a Medicare beneficiary was admitted to a hospital, that would fall under Part A that has a set deducible per benefit period.
Medicare Cost Estimates Of Marginal Value
Because the prices and member costs are national averages, the cost estimator tool is of limited value. It will give people an average cost they might face for a particular procedure IF they only have original Medicare Parts A and B. If the Medicare patient has a Medicare Advantage Plan that is an HMO, many of the member cost sharing will be dictated by the plan benefits, not Medicare. If the Medicare beneficiary has a Medicare Medigap or Supplement plan, that extra coverage may pick up some or all of the member cost share for a given procedure.
Hospital Prices Are More Expensive
What is most surprising is the cost differential between outpatient ambulatory surgery centers and hospitals. Some of the member cost sharing is double what it is with a surgery center. Hospitals are expensive to both the patient and to Medicare.
| Procedure | CPT Code | Surgery Center | Hospital | % |
| Breast removal | 19303 | $409 | $962 | 135% |
| Cataract removal | 66934 | $198 | $384 | 94% |
| Colonoscopy | 45380 | $98 | $187 | 91% |
| Epidural injections | 64483 | $70 | $134 | 91% |
| Gallbladder removal | 47652 | $419 | $898 | 114% |
| Knee joint repair | 29884 | $256 | $529 | 107% |
| Prostate biopsy | 55700 | $156 | $339 | 117% |
Anticipate Hidden Fees Like Doctor Bills
Of course, there are always hidden costs for other services provided. In California, doctor’s bill separately from hospitals, so that may be a separate fee. Once you have met your Part B deductible, health care services such as office visits and many procedures are subject to 20% coinsurance. Plus, you may need follow up visits, labs, other tests, and imaging, which can all add up to more than just the base procedure.
What good is the Medicare cost estimator tool if there are so many variables? If you are looking to save money, then try to find an outpatient surgery center with a good reputation. They charge Medicare less for the same procedure than a hospital does. That means you save money.
