Last November, CMS finalized its healthcare price transparency rule, which next year requires hospitals to disclose online the rates they negotiate with insurers.
Hospitals are required to publicize the payer-specific negotiated rates of 300 "shoppable services," defined as those that can be scheduled directly and in advance by a consumer. Seventy of the services are mandated by CMS. Hospitals can decide the other 230 services they post online.
CMS recently unveiled the 70 mandated-services in a presentation. They are listed below, along with the correct CPT, HCPCS or DRG Primary code.
Evaluation and Management Services
1. Psychotherapy, 30 minutes (90832)
2. Psychotherapy, 45 minutes (90834)
3. Psychotherapy, 60 minutes (90837)
4. Family psychotherapy, not including patient, 50 minutes (90846)
5. Family psychotherapy, including patient, 50 min (90847)
6. Group psychotherapy (90853)
7. New patient office or other outpatient visit, typically 30 min (99203)
8. New patient office of other outpatient visit, typically 45 min (99204)
9. New patient office of other outpatient visit, typically 60 min (99205)
10. Patient office consultation, typically 40 min (99243)
11. Patient office consultation, typically 60 min (99244)
12. Initial new patient preventive medicine evaluation, for those ages 18 to 39 (99385)
13. Initial new patient preventive medicine evaluation, for those ages 40 to 64 (99386)
Laboratory and Pathology Services
14. Basic metabolic panel (80048)
15. Blood test, comprehensive group of blood chemicals (80053)
16. Obstetric blood test panel (80055)
17. Blood test, lipids (80061)
18. Kidney function panel test (80069)
19. Liver function blood test panel (80076)
20. Manual urinalysis test with examination using microscope (81000 or 81001)
21. Automated urinalysis test (81002 or 81003)
22. Prostate specific antigen (84153 or 84154)
23. Blood test, thyroid stimulating hormone (84443)
24. Complete blood cell count, with differential white blood cells, automated (85025)
25. Complete blood count, automated (85027)
26. Blood test, clotting time (85610)
27. Coagulation assessment blood test (85730)
Radiology Services
28. CT scan, head or brain, without contrast (70450)
29. MRI scan of brain before and after contrast (70553)
30. X-Ray, lower back, minimum four views (72110)
31. MRI scan of lower spinal canal (72148)
32. CT scan, pelvis, with contrast (72193)
33. MRI scan of leg joint (73721)
34. CT scan of abdomen and pelvis with contrast (74177)
35. Ultrasound of abdomen (76700)
36. Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus (76805)
37. Ultrasound pelvis through vagina (76830)
38. Mammography of one breast (77065)
39. Mammography of both breasts (77066)
40. Mammography, screening, bilateral (77067)
Medicine and Surgery Services
41. Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities (216)
42. Spinal fusion except cervical without major comorbid conditions or complications (460)
43. Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (470)
44. Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications (473)
45. Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications (743)
46. Removal of 1 or more breast growth, open procedure (19120)
47. Shaving of shoulder bone using an endoscope (29826)
48. Removal of one knee cartilage using an endoscope (29881)
49. Removal of tonsils and adenoid glands patient younger than age 12 (42820)
50. Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope (43235)
51. Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (43239)
52. Diagnostic examination of large bowel using an endoscope (45378)
53. Biopsy of large bowel using an endoscope (45380)
54. Removal of polyps or growths of large bowel using an endoscope (45385)
55. Ultrasound examination of lower large bowel using an endoscope (45391)
56. Removal of gallbladder using an endoscope (47562)
57. Repair of groin hernia patient age 5 or older (49505)
58. Biopsy of prostate gland (55700)
59. Surgical removal of prostate and surrounding lymph nodes using an endoscope (55866)
60. Routine obstetric care for vaginal delivery, including pre-and post-delivery care (59400)
61. Routine obstetric care for cesarean delivery, including pre-and post-delivery care (59510)
62. Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care (59610)
63. Injection of substance into spinal canal of lower back or sacrum using imaging guidance (62322 or 62323)
64. Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (64483)
65. Removal of recurring cataract in lens capsule using laser (66821)
66. Removal of cataract with insertion of lens (66984)
67. Electrocardiogram, routine, with interpretation and report (93000)
68. Insertion of catheter into left heart for diagnosis (93452)
69. Sleep study (95810)
70. Physical therapy, therapeutic exercise (97110)
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