Average Reimbursement

Centers for Medicare & Medicaid Services (CMS), issued price transparency requirements for hospitals to establish, update, and make public a list of their standard charges for items and services they provide. (45 CFR § 180.50)

These actions are to promote price transparency in health care and public access to hospital standard charges.

Starting January 1, 2021, each hospital operating in the United States is required to provide clear, accessible pricing information online.

Average Charge per Case: Avg Chrg/Case represents the patient populations at both locations discharged 6/1/2019 – 8/31/2020 listed by MS-DRG (diagnosis related group) or CPT where at least 10 or more patients were billed for the specified MS-LTC-DRG or CPT

Discounted Cash Price: RML does not provide discounts to uninsured patients unless they are eligible for financial assistance. Please refer to RML Specialty Hospital Financial Assistance Policy for more information.

Click here to download the Excel version of the Average Reimbursement.
 

MS-DRG Description Avg Chrg/Case Avg Reimb/Case Min Charge Max Charge
207 Respiratory system diagnosis with ventilator support >96 hours $230,294 $89,032 $43,529 $585,855
189 Pulmonary edema and respiratory failures $121,931 $59,108 $36,745 $429,840
208 Respiratory system diagnosis with ventilator support <=96 hours $83,825 $33,628 $31,732 $124,651
981 Extensive O.R. procedures unrelated to principal diagnosis with MCC $363,680 $132,839 $76,990 $539,281
166 Other respiratory system O.R. procedures with MCC $276,341 $119,891 $71,640 $554,723
539 Osteomyelitis with MCC $122,510 $70,685 $45,640 $220,184
919 Complications of treatment with MCC $262,945 $131,598 $65,293 $501,313
949 Aftercare with CC/MCC $92,562 $47,005 $37,593 $183,907
177 Respiratory infections and inflammations with MCC $83,934 $44,170 $42,984 $114,043
579 Other skin, subcutaneous tissue and breast procedures with MCC $221,369 $111,315 $59,103 $403,630
682 Renal failure with MCC $114,012 $56,615 $40,173 $160,265
288 Acute and subacute endocarditis with MCC $102,682 $48,356 $29,679 $150,372
638 Diabetes with CC $90,208 $46,226 $42,013 $107,604


 

 

CPT Description Avg Chrg/Case Avg Reimb/Case Min Charge Max Charge
99291 Critical care 1st hour $350 $243 $239 $316
99221 History and physical level 1 $167 $112 $110 $145
99222 History and physical level 2 $228 $150 $148 $195
99223 History and physical level 3 $335 $219 $216 $285
99238 Hospital discharge $124 $79 $78 $105
99239 Hospital discharge more 30 min $179 $115 $114 $152
90832 Indiv psych interv 20-30 min $115 $67 $66 $97
32556 Insert chest tube $650 $139 $136 $553
90791 Psych interview $283 $133 $132 $240
99231 Subsequent hospital level 1 $69 $43 $42 $59
99232 Subsequent hospital level 2 $123 $78 $77 $105
99233 Subsequent hospital level 3 $177 $112 $111 $150
31525 Tracheoscopy $650 $180 $176 $553
94002 Vent management initial-physician fee $250 $101 $99 $213
94003 Vent mgmt subsequent-physician fee $175 $73 $72 $149