Medicare Payment Information for Common Outpatient Services - News Release

Contact: Paul Hambke, Press Secretary
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Harrisburg, PA - May 7, 2013 - The Pennsylvania Health Care Cost Containment Council (PHC4) today launched an updated version of its interactive database of Medicare payments for common outpatient treatments that can help empower consumers by providing consistent payment information for common health care services. The update uses Medicare figures from 2011.

Located at, the database provides consumers with the amount Medicare pays hospital outpatient departments and freestanding outpatient centers for 78 common services, treatments and procedures such as colonoscopies, cataract surgeries and MRIs. The online service is searchable for all 67 Pennsylvania counties.

“Knowing where to begin negotiating fees for health care can be useful in reducing costs, particularly for people in a consumer-driven health plan with a Health Savings Account, or those who are uninsured,” said Joe Martin, PHC4’s executive director. “For those paying out of pocket for many outpatient services, knowing what Medicare pays gives people a reference point in negotiating for a better price.”

A recent study by the Towers Watson Business Group on Health noted that 66% of companies with 1,000 or more employees offered at least one high deductible health plan with a health savings account for medical expenses. The figure is expected to grow to 80% next year and nearly 15% of companies surveyed, an account-based plan was the only option, up from 7.6% in 2010.

While commercial health plans may pay hospitals more than Medicare, the Medicare rates serve as a consistent benchmark and can help in any negotiations with healthcare providers over price. If you have insurance, your plan may also have posted payment data on their own website so you can check that as well. Make sure it is payment for a procedure and not a facility charge.

By clicking on PHC4’s Medicare drop down menu, you can find out how much the federal program pays local hospitals and outpatient procedure centers for 78 common outpatient treatments, services and procedures. Just pick the service you are interested in, and then select COUNTY to access the payment. You can select by hospital or by outpatient procedure center. If you do not receive a response from the website, the data may not be available.

For many people, choosing a health care provider is not just a matter of price, Martin notes. “Decisions about where to receive health care services should not be made solely on the basis of costs and charges. The facility’s reputation and its experience and effectiveness in treating patients for a particular procedure or providing a specific service should also be factors in selecting a facility,” Martin said.

The payment amounts reported in the Medicare database reflect only the payment to the facility and do not include any professional fees (e.g., physician) and other possible fees that may be associated with a procedure.

According to Martin, releasing the latest Medicare figures is part of PHC4’s continuing effort to make health care in Pennsylvania transparent by providing data about the cost and quality of health care available to commonwealth residents. PHC4 first released Medicare outpatient data in March 2011.

PHC4 is an independent state agency charged with collecting, analyzing and reporting information about the cost and quality of health care in Pennsylvania.