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Average Charge and Payment Data for 13 Orthopedic Procedures Commonly Performed in ASCs Print E-mail
Written by Stephanie Wasek   
Thursday, 21 August 2008
Here is the average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for 13 orthopedic procedures commonly performed in ASCs.

1. Obtaining small amount of bone for graft (CPT 20900)
- average sub charge: $2,060
- average allow charge $294
- average payment: $231

2. Open surgical partial removal of collar bone (CPT 23120)
- average sub charge: $3,793
- average allow charge $477
- average payment: $376

3. Partial repair or removal of shoulder bone (CPT 23130)
- average sub charge: $4,027
- average allow charge $478
- average payment: $377

4. Open repair of rotator cuff, recent (CPT 23410)
- average sub charge: $4,947
- average allow charge $671
- average payment: $530

5. Open repair of rotator cuff, old (CPT 23412)
- average sub charge: $5,556
- average allow charge $984
- average payment: $777

6. Reconstruction rotator cuff, old (CPT 23420)
- average sub charge: $5,653
- average allow charge $984
- average payment: $777

7. Open repair elbow fracture involving ulnar bone (CPT 24685)
- average sub charge: $3,965
- average allow charge $502
- average payment: $396

8. Wrist fracture pinning through skin (CPT 25606)
- average sub charge: $2,883
- average allow charge $487
- average payment: $386

9. Open surgical Treatment wrist fracture (radius) (CPT 25607)
- average sub charge: $4,240
- average allow charge $706
- average payment: $560

10. Shoulder scope, repair cartilage tear (CPT 29807)
- average sub charge: $4,426
- average allow charge $309
- average payment: $241

11. Shoulder scope, partial removal collar bone (CPT 29824)
- average sub charge: $4,605
- average allow charge $562
- average payment: $442

12. Shoulder scope, bone shaving (CPT 29826)
- average sub charge: $4,680
- average allow charge $309
- average payment: $244

13. Shoulder scope, rotator cuff repair (CPT 29827)
- average sub charge: $5,272
- average allow charge $693
- average payment: $547

 
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