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How Much Does Medicare Usually Pay for Healthcare?

Primary Listings

2011 Medicare Reimbursement for Orthopedic Surgery

Written for medical and coding professionals, this set of guides called Coding Resources, shows Medicare average payment for hip and knee replacement, shoulder repair, elbow arthroplasty, and other orthopedic procedures. Difficult for consumers to understand, esp. since prices may be 3 or 4 times higher; uses CPT, ICD9-CM codes and MS-DRGs, with physician, inpatient, and outpatient payment rates through Dec. 31, 2011. From Zimmer, a $4.2 billion global company that makes products for orthopedic surgeons to use

Average Medicare Payments for Hospital Outpatient Services

Average 2007 Medicare costs for outpatient procedures commonly performed in hospitals, listed by county and state, as well as US overall average Medicare payment. Check file of 61 Procedures that include scope of colon (colonoscopy), or shoulder, upper stomach-intestine scope, bladder exam, scope removal of tumors, stents; removal of damaged skin; rotator cuff repair; breast biopsy, prostate needle biopsy, other biopsy with scope procedures; cataract removal & lens insert, and post-cataract laser surgery; hemodialysis access; injection of lower back; breaking up kidney stones, wrist fracture surgery, hernia repair, nerve block injections and more. File of 20 procedures has x-ray, cardiac cath, scans, carpal tunnel, gall bladder, hernia repair. Preventive services file has vaccines and immunizations. Three files could contain any procedure. Shows volume and Medicare payment, but not original charges. Knowing the CPT code might help you find the right procedure. Not at all user-friendly, Excel format, but covers every state. Oct. 2008

Other Helpful Listings

Healthcare Expenses for Seniors (MEPS 2006 data)

Special report on Health Care Expenditures for the Elderly Age 65 and over, shows median annual expenditures were $4032 in 2006, vs. $2204 in 1996. Average expenses for those with expense were $9080. Medicare paid about 61%; private insurance paid 14%; out-of-pocket amount was 15%. Nearly 97% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $174 per purchase. For seniors, the inpatient room rate averaged $2714 per day (2006); ER visit was $651 on average; office visit was $180. MEPS Statistical Brief #256, Aug. 2009

Pennsylvania Total Hip and Knee Replacements FY 2013 (pdf)

June 2015 report by PHC4 shows volume and readmission rates by hospitals in Penn. Average PA hospital charges also shown, with 2013 prices (excluding surgeon fee) at $52,912 and $55,493 for knees and hip replacements, respectively. Separately, consumers can find surgeon volume and what Medicare paid (less than 25% of the average charge)

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