99422

Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes

Medicare pricing data for 7,301 providers across 50 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

Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes (HCPCS code 99422) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $28.29, but hospitals typically charge $78.76 — a 2.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.66

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $28.29, your out-of-pocket cost would be approximately $5.66. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$28.29
Average Hospital Charge
$78.76
Markup Ratio
2.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$78.76
Medicare Allowed$28.29
Medicare Payment$20.58

Hospitals charge 2.8x more than what Medicare allows for this procedure. Medicare actually pays $20.58 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$33$742321,295+16.5%
Alaska$33$931554+16.1%
District of Columbia$33$4931107+15.4%
New York$32$862902,773+13.2%
New Jersey$31$146102753+8.2%
California$30$1181,2148,486+6.4%
Connecticut$30$712368+5.3%
Illinois$29$703481,677+3.4%
Delaware$29$8014133+2.5%
Massachusetts$29$9974206+2.1%
New Hampshire$29$52932+1.7%
Washington$29$803541,434+1.4%
Florida$29$703641,879+1.2%
Vermont$29$404136+1.1%
Texas$28$6152810,897-1.1%
Wyoming$28$113914-2.4%
Arizona$27$55125805-2.9%
Virginia$27$58139501-3.5%
Oregon$27$85129320-4.5%
Hawaii$27$7723103-4.9%
Georgia$27$12389314-5.2%
New Mexico$27$7519144-5.4%
Nevada$27$6722258-5.4%
Minnesota$27$79423895-5.5%
North Carolina$27$753121,196-5.9%
Maine$27$631135-6.1%
Colorado$26$6871253-6.7%
Montana$26$741331-7.2%
Pennsylvania$26$67265872-7.7%
Missouri$26$7162191-7.8%
Alabama$26$553055-8.0%
Tennessee$26$491671,242-8.2%
Ohio$26$615661,804-8.6%
Michigan$26$774611,382-8.6%
South Carolina$26$6574262-8.7%
Kentucky$26$604084-9.8%
Puerto Rico$26$61625-9.8%
West Virginia$25$732130-11.1%
Louisiana$25$6767185-11.8%
Oklahoma$25$3839979-12.5%
Kansas$25$802358-13.1%
Iowa$24$9376197-13.8%
Wisconsin$24$68117517-14.1%
Indiana$24$7571209-14.4%
North Dakota$24$731222-15.3%
Mississippi$24$543264-16.9%
Arkansas$23$582256-18.1%
Nebraska$23$6759479-19.9%
Utah$22$8019119-22.4%
Idaho$21$681992-26.0%

⚠️ 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