Payment Variations Between States for 10 Common Surgery Center Procedures

Here are 10 common ASC procedures, listed by CPT code and description, with the Medicare reimbursement rates from the highest and lowest reimbursing state, according to SDI’s 2008 Outpatient Surgery Center Market Report.

• 19302 (Remove breast partial, & underarm lymph nodes) – Highest: $852 (California); Lowest: $561 (South Carolina)
• 20900 (Obtaining small amount of bone for graft) – Highest: $394 (Missouri); Lowest: $194 (New York)
• 23120 (Open surgical partial removal of collarbone) – Highest: $615 (Massachusetts); Lowest: $293 (West Virginia)
• 25606 (Wrist fracture pinning through skin) – Highest: $441 (Alaska); Lowest: $302 (California)
• 29807 (Shoulder scope, repair cartilage tear) – Highest: $425 (New Hampshire); Lowest: $196 (West Virginia)
• 36821 (Hemodialysis access by joining artery and vein) – $423 (Washington); Lowest: $114 (Maryland)
• 43236 (Stomach-intestine scope, injection intestine wall) – $356 (Maine); Lowest: $174 (New Mexico)
• 44360 (Scope of upper small intestine) – $386 (Connecticut); $279 (North Dakota)
• 52353 (Scope bladder & ureter, break up kidney stone) – Highest: $521 (Minnesota); Lowest: $394 (South Carolina)
• 52648 (Laser vaporization of prostate for urine flow) – $1,167 (New York); $601 (Virginia)

Source: SDI’s 2008 Outpatient Surgery Center Market Report.

To learn more about SDI and this report, go to www.sdihealth.com.

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