The tool, Procedure Price Lookup, will display national averages for the amount Medicare pays hospitals compared to ASCs for certain surgeries. It will also relay the national average copayment a beneficiary without a supplemental Medicare plan would owe the provider in a given setting.
For example, if a Medicare beneficiary is scheduled to undergo knee surgery, the tool will allow the beneficiary to type in the name of a certain surgery or its specific code in a search bar. Then, a display will pop up of the estimated out-of-pocket costs for the procedure at a hospital outpatient department compared to an ASC.
The launch of CMS’ Procedure Price Lookup is required by the 21st Century Cures Act. The law requires Medicare to pay different types of healthcare providers under separate payment systems, which means the cost of the same service at a different site of care can be significantly higher or lower, depending on the site.
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