Service | Cost ($) | Source a | Description b |
---|---|---|---|
Medical office visits | |||
Primary care physician visits | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Nurse practitioner/physician’s assistant/nurse visits | 20.41 | Medicare physician fee schedule24 | 99211: Outpatient E&M visit, that may not require the presence of a physician, presenting problems are minimal |
Telephone consultations | 43.89 | Medicare physician fee schedule24 | 99212: Office E&M visit involving straightforward decision making |
Medical/surgical special visits | |||
Oncology, medical | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Hematology | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Nononcology | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Other | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Laboratory visits | 23.82 | Medicare physician fee schedule24 | 36591: Collection of blood specimen from venous access device |
Specific laboratory tests | |||
Hematology | 10.69 | Medicare clinical lab fee schedule30 | 85025: CBC with automated differential WBC |
Clinical chemistry | 14.53 | Medicare clinical lab fee schedule30 | 80053: Comprehensive metabolic panel Comprises: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520) |
Liver function tests | 11.23 | Medicare clinical lab fee schedule30 | 80076: Hepatic function panel Comprises: Albumin (82040) Bilirubin, direct (82248) Bilirubin, total (82247) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) |
Pancreatic (amylase and lipase) | 19.38 | Medicare clinical lab fee schedule30 | 82150: Assay of amylase 83690: Assay of lipase |
Coagulation | 25.99 | Medicare clinical lab fee schedule30 | 85610: Prothrombin time 85730: Thromboplastin time partial 85049: Automated platelet count 85002: Bleeding time test |
Urinalysis | 4.35 | Medicare clinical lab fee schedule30 | 81000: Urinalysis, by dip stick or tablet reagent, nonautomated, with microscopy |
ECG | 18.37 | Medicare physician fee schedule24 | 93000: Electrocardiogram complete |
Thyroid function | 56.74 | Medicare physician fee schedule24 | 83970: Assay of parathormone |
Other | 20.16 | — | Assigned mean value for specific lab tests |
Radiological visits | 75.77 | Medicare physician fee schedule24 | 99214: Office E&M visit involving decision making of moderate complexity |
Radiological tests | |||
CT or MRI | 179.98 | 2013 National Physician Fee Schedule37 | 74150: CT scan of abdomen without contrast material Work RVU: 1.19, facility practice expenses RVU: 4.02, malpractice expenditures RVU: .08, Conversion factor: 34.023 |
DCE MRI | 461.35 | 2013 National Physician Fee Schedule37 | 76390: Magnetic resonance spectroscopy |
PET scan | 1,056.12 | GE Healthcare Reimbursement for PET 201331 | 78811: Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck) |
PET/CT scan | 1,056.12 | GE Healthcare Reimbursement for PET 201331 | 78811: Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck) |
Bone scan | 108.19 | Medicare physician fee schedule24 | 77075: X-rays, bone survey, complete |
Other | 261.00 | — | Assigned mean value for specific radiological tests |
Home health visits | 78.59 | Medicare physician fee schedule24 | 99325: Domiciliary/rest home visit; new patient, presenting problems of moderate severity |
Hospital days (hospitalization at least 24 hours) | |||
General ward | 2,406.18 | National statistics on all stays from HCUPnet;27 Calculation; Medicare physician fee schedule24 | ICD-9-CM code: 189.0-Malignant neoplasm: Kidney, except pelvis Kidney not otherwise specified Kidney parenchyma 99232: Subsequent hospital care, per day, for E&M of patient involving decision making of moderate complexity |
ICU | 4,672.95 | Halpern and Pastores, 201028 | $3,518 in 2005 USD inflated to 2013 USD using medical care Consumer Price Index from Bureau of Labor Statistics |
Emergency room visits | 222.76 | Bamezai et al., 200529 | — |
Medical/surgical procedures | |||
At outpatient/physician clinic | 0.00 | — | The costs of medical/surgical procedures were assumed to be included in the costs of outpatient visits and hospitalizations |
During any hospitalization | 0.00 | — | The costs of medical/surgical procedures were assumed to be included in the costs of outpatient visits and hospitalizations |
a Citations for these sources are found in the References listed at the end of this article.
b Unless otherwise indicated, CPT codes are used in this column.
BUN = blood urea nitrogen; CBC = complete blood count; CPT = Current Procedural Terminology; CT = computed tomography; DCE MRI = dynamic contrast-enhanced magnetic resonance imaging; E&M = evaluation and management; ECG = electrocardiogram; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; ICU = intensive care unit; RVU = relative value unit; SGOT = serum glutamic oxaloacetic transaminase; SGPT = serum glutamic pyruvic transaminase; USD = U.S. dollars; WBC = whole blood count.