99316

Nursing facility discharge management, more than 30 minutes

Medicare pricing data for 19,754 providers across 52 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Nursing facility discharge management, more than 30 minutes (HCPCS code 99316) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $119.25, but hospitals typically charge $243.62 — a 2.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$23.85

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $119.25, your out-of-pocket cost would be approximately $23.85. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$119.25
Average Hospital Charge
$243.62
Markup Ratio
2.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$243.62
Medicare Allowed$119.25
Medicare Payment$93.29

Hospitals charge 2.0x more than what Medicare allows for this procedure. Medicare actually pays $93.29 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$167$50439263+40.4%
California$134$2681,14927,171+12.6%
New York$133$2591,46238,857+11.9%
District of Columbia$132$21239476+10.9%
North Dakota$131$267881,053+10.1%
New Jersey$130$24381616,965+9.0%
Hawaii$126$29384950+5.8%
Maryland$122$20558715,092+2.6%
West Virginia$121$2041341,821+1.7%
Nevada$120$2821585,233+0.7%
Illinois$120$24475513,366+0.5%
Florida$120$24596923,206+0.3%
Massachusetts$119$25164418,352-0.1%
Arizona$119$2342786,496-0.3%
Pennsylvania$118$2161,11818,124-1.1%
Rhode Island$118$22861734-1.2%
Connecticut$118$2063318,087-1.4%
Texas$117$22892410,790-1.6%
South Dakota$116$286104668-2.3%
Montana$116$2681221,311-2.4%
Vermont$116$257621,003-2.6%
Washington$116$3083807,771-2.7%
Colorado$115$2243545,362-3.2%
Michigan$115$25868312,588-3.5%
Virginia$115$20967316,641-3.6%
Wyoming$115$29447326-3.6%
Maine$115$2741952,026-3.7%
Missouri$115$2082823,813-3.7%
New Hampshire$114$2341822,403-4.0%
Georgia$114$2073515,637-4.3%
Delaware$113$227842,473-4.9%
Oklahoma$113$2831672,657-5.1%
Oregon$113$3002092,967-5.2%
New Mexico$113$2661031,170-5.4%
Ohio$113$21785211,491-5.6%
Louisiana$112$2133122,921-6.1%
Utah$112$340842,110-6.1%
Minnesota$111$3175708,114-6.5%
North Carolina$111$24177813,750-6.6%
Kentucky$110$2133304,198-7.6%
Wisconsin$110$3074216,324-7.6%
Alabama$110$1951952,259-7.8%
South Carolina$109$1814178,111-8.6%
Iowa$109$2683332,778-8.8%
Idaho$109$2271573,080-8.8%
Puerto Rico$108$115417-9.1%
Kansas$108$2852684,800-9.1%
Arkansas$108$174124946-9.4%
Indiana$108$2204527,847-9.7%
Mississippi$108$2751742,562-9.7%
Tennessee$106$2234959,039-11.2%
Nebraska$106$2611482,740-11.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber