Here's what CMS pays for 6 orthopedic procedures for ASCs vs. HOPDs

CMS released a new tool allowing patients to compare the average payment of select procedures in hospital outpatient departments and ASCs.

The Procedure Price Lookup Tool shows the national averages for the amount Medicare pays an ASC or hospital, as well as the national average copayment amount a patient without Medicare supplemental insurance owes in each setting.

Here are how five orthopedic procedure costs compare in HOPDs and ASCs:

1. Arthroplasty, knee, tibial plateau (27440)
ASC:
• Average Medicare pays: $5,835
• Average total cost: $7,294
• Amount patient pays on average: $1,459

HOPD:
• Average Medicare pays: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340

2. Arthroscopy, knee, surgical; with meniscus repair (29882)
ASC:
• Average Medicare pays: $1,024
• Average total cost: $2,280
• Amount patient pays on average: $256

HOPD:
• Average Medicare pays: $2,116
• Average total cost: $2,645
• Amount patient pays on average: $529

3. Total disc arthroplasty with discectomy (22856)
ASC:
• Average Medicare pays: $8,970
• Average total cost: $11,213
• Amount patient pays on average: $2,243

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

4. Sacroiliac joint fusion (27279)
ASC:
• Average Medicare pays: $9,965
• Average total cost: $12,456
• Amount patient pays on average: $2,491

HOPD:
• Average Medicare pays: $14,031
• Average total cost: $15,371
• Amount patient pays on average: $1,340

5. Anterior cervical discectomy (22551)
ASC:
• Average Medicare pays: $5,870
• Average total cost: $7,337
• Amount patient pays on average: $1,467

HOPD:
• Average Medicare pays: $8,783
• Average total cost: $10,123
• Amount patient pays on average: $1,340

6. Laminotomy foraminotomy decompression (63030)
ASC:
• Average Medicare pays: $2,177
• Average total cost: $2,721
• Amount patient pays on average: $544

HOPD:
• Average Medicare pays: $4,485
• Average total cost: $5,606
• Amount patient pays on average: $1,121

More articles on orthopedics and TJR:
Study identifies reasons for failed same-day discharge after outpatient total hip arthroplasty: 4 details
Demand for orthopedic care fuels growth of new outpatient facilities across the US: 3 details
Orthopedic Associates of Hartford invested $30M in a new ASC — Drs. Pietro Memmo& Andrew Caputo explain why

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