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CMS pay for 10 cardiology procedures at ASCs vs. HOPDs

CMS' procedure price look-up tool allows users to compare average pay for procedures in ASCs and hospital outpatient departments.

The tool shows national averages for the amount Medicare pays an ASC or hospital, and the national average copayment a patient without Medicare supplemental insurance owes in each setting.

Here's what 10 cardiology procedures cost at ASCs and hospital outpatient departments:

1. Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber (code: 33249)

ASC
Total cost: $27,655
Medicare pays: $22,124
Patient pays: $5,530

HOPD
Total cost: $33,779
Medicare pays: $32,107
Patient pays: $1,672

2. Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system (code: 33264)

ASC
Total cost: $27,027
Medicare pays: $21,261
Patient pays: $5,405

HOPD
Total cost: $33,255
Medicare pays: $31,687
Patient pays: $1,567

3. Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular (code: 33208)

ASC
Total cost: $8,422
Medicare pays: $6,738
Patient pays: $1,683

HOPD
Total cost: $10,934
Medicare pays: $9,343
Patient pays: $1,590

4. Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel (code: 37184)

ASC
Total cost: $7,079
Medicare pays: $5,662
Patient pays: $1,415

HOPD
Total cost: $10,479
Medicare pays: $8,907
Patient pays: $1,571

5. Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance (code: 37187)

ASC
Total cost: $6,940
Medicare pays: $5,551
Patient pays: $1,387

HOPD
Total cost: $10,439
Medicare pays: $8,875
Patient pays: $1,563

6. Placement through the skin of drug eluding heart vessel stent(s), with vessel imaging; single major coronary artery or branch (code: C9600)

ASC
Total cost: $6,264
Medicare pays: $5,011
Patient pays: $1,252

HOPD
Total cost: $10,042
Medicare pays: $8,558
Patient pays: $1,484

7. Blinded clinical trial procedure implantation of interatrial shunt or placebo that includes right heart catheterization, transesophageal echo or intracardiac echo, and all imaging guidance if performed (code: C9758)

ASC
Total cost: $6,316
Medicare pays: $5,053
Patient pays: $1,263

HOPD
Total cost: $17,500
Medicare pays: $16,016
Patient pays: $1,484

8. Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein (code: 37248)

ASC
Total cost: $2,456
Medicare pays: $1,965
Patient pays: $491

HOPD
Total cost: $5,256
Medicare pays: $4,205
Patient pays: $1,051

9. Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed (code: 93458)

ASC
Total cost: $1,702
Medicare pays: $1,361
Patient pays: $339

HOPD
Total cost: $3,198
Medicare pays: $2,273
Patient pays: $923

10. Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed (code: 93451)

ASC
Total cost: $1,535
Medicare pays: $1,228
Patient pays: $306

HOPD
Total cost: $3,031
Medicare pays: $2,140
Patient pays: $890

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