Table.
Median MA-to-TM price ratio across all MSAs | ||
---|---|---|
Service | Median Price Ratio | N (# of MSAs) |
Low-complexity E&M office visit with established patient (CPT 99213) | 1.01 | 165 |
Routine electrocardiogram, complete (CPT 93000) | 1.00 | 49 |
Low-complexity E&M office visit: Median MA-to-TM price ratio, by benchmark level | |||
---|---|---|---|
Range of Benchmark Ratios (relative to FFS) | Mean Benchmark Ratio (relative to FFS) | Median Price Ratio | N (# of MSAs) |
0.95 ≤ ratio ≤ 0.975 | 0.95 | 1.01 | 49 |
0.975 < ratio ≤ 1.025 | 1.00 | 1.01 | 39 |
1.025 < ratio ≤ 1.125 | 1.07 | 1.02 | 58 |
1.125 < ratio ≤ 1.15 | 1.15 | 1.02 | 19 |
MA indicates Medicare Advantage; TM, Traditional Medicare; MSA, Metropolitan Statistical Area; E&M, evaluation and management; CPT, Current Procedural Terminology; FFS, fee-for-service