Average Reimbursement

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.

 

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

 

 

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