Medicare’s latest resource for patients could save you money every time you need an outpatient procedure.
The federal health care program that primarily serves folks ages 65 and older calls this new tool “Procedure Price Lookup.” You can access it online for free.
The tool helps trim costs of outpatient procedures, which generally include services for which you do not need to be formally admitted to a health care facility.
The Centers for Medicare & Medicaid Services launched the tool in response to a requirement of the 21st Century Cures Act, federal legislation that former President Barack Obama signed into law in December 2016.
How it works
To use Medicare’s Procedure Price Lookup tool, type the name of an outpatient procedure into the search box. Or, select the procedure from a list of options that appear once you start typing.
If you are unsure of the exact name of a procedure, ask your doctor. To be sure you have the right procedure, it helps also to ask your doctor for the corresponding billing code.
Once you have the right procedure, the tool will show you various dollar amounts for the procedure.
These amounts include the national average:
- Copayments that Medicare beneficiaries without supplemental insurance pay when having the procedure performed at ambulatory surgical centers and at hospitals’ outpatient departments.
- Amounts that Medicare pays to ambulatory surgical centers and hospitals at which the procedure is performed.
Say you need a kneecap repair. This screenshot shows what the tool would tell you about the procedure:
Medicare defines ambulatory surgical centers as facilities at which certain surgeries can be performed for patients who aren’t expected to need more than 24 hours of care.
Why costs vary
If you pull up a few procedures via the Procedure Price Lookup tool, you might notice a pattern of large price variation depending on whether the procedure occurs at a hospital or an ambulatory surgical center.
Medicare regulations require separate payment systems for different types of health care facilities. Due to this, different facilities can charge the Medicare program and patients different amounts for the same procedure.
Patients who are unaware of this might not realize how much more a procedure costs at one type of facility compared with another until they get a bill.
As Seema Verma, administrator of the Centers for Medicare & Medicaid Services, writes in a recent blog post about the new tool:
“Can you imagine going to the grocery store, getting the groceries you need for the week, but never knowing the price of your items until a week later when the store sends you a bill? Sadly, that’s how health care works every day.”
Verma notes that it would take an act of Congress to change the ways different types of facilities charge for the same procedure.
Until then, patients now have the Procedure Price Lookup tool. Using it before going in for a procedure can potentially save you hundreds if not thousands of dollars.
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