CMS pay for 5 cardiology procedures at ASCs vs. HOPDs

Advertisement

Across five common cardiology procedures, ASCs consistently post lower total costs than hospital outpatient departments — in some cases by more than $6,000 per case — driven largely by lower facility fees. 

However, the patient’s share of the bill doesn’t always follow the same pattern. While ASCs generally mean lower out-of-pocket costs for procedures like PCI, pacemaker implants and coronary angiography,  HOPDs carry lower copays for higher-acuity procedures such as atrial fibrillation ablations and ICD implants.

Here’s what five cardiology procedures cost at ASCs and hospital outpatient departments, using data from CMS’ procedure price lookup tool:

1. Percutaneous coronary intervention with stenting (CPT code 92928)

ASCs:

  • Patient pays: $1,553
  • Total cost: $7,771
  • Physician fee: $463
  • Facility fee: $7,308
  • Medicare pays: $6,217

HOPDs:

  • Patient pays: $1,828
  • Total cost: $12,257
  • Physician fee: $463
  • Facility fee: $11,794
  • Medicare pays: $10,429

2. Comprehensive EP evaluation and ablation for atrial fibrillation (CPT code 93656)

ASCs:

  • Patient pays: $4,212
  • Total cost: $21,061
  • Physician fee: $806
  • Facility fee: $20,255
  • Medicare Pays: $16,849

HOPD:

  • Patient pays: $1,897
  • Total cost: $27,509
  • Physician fee: $806
  • Facility fee: $26,703
  • Medicare pays: $25,612

3. Insertion of new or replacement of permanent pacemaker with transvenous electrode (CPT code 33206)

ASCs: 

  • Patient pays: $1,536
  • Total cost: $7,686
  • Physician fee: $402
  • Facility fee: $7,284
  • Medicare pays: $6,148

HOPD:

  • Patient pays: $1,816
  • Total cost: $11,080
    Physician fee: $402
    Facility fee: $10,678
    Medicare pays: $9,263

4. Catheter placement in coronary artery for coronary angiography.(CPT code 93454)

ASC: 

  • Patient pays: $516
  • Total cost: $2,584
  • Physician fee: $877
  • Facility fee: $1,707
  • Medicare pays: $2,068

HOPD: 

  • Patient pays: $1,038
  • Total cost: $4,189
  • Physician fee: $877
  • Facility fee: $3,312
  • Medicare pays: $3,150

5. Insertion or replacement of permanent implantable defibrillator system (CPT code 33249)

ASC:

  • Patient pays: $5,114
  • Total cost: $25,572
  • Physician fee: $797
  • Facility fee: $24,775
  • Medicare pays: $20,458

HOPD: 

  • Patient pays: $1,895
  • Total cost: $32,865
  • Physician fee: $797
  • Facility fee: $32,068
  • Medicare pays: $30,970
Advertisement

Next Up in Cardiology

Advertisement