Median facility payments range from approximately $300-$3,000 for low to high severity cases

A new Data Byte analyzing payment information in the Colorado All Payer Claims Database (CO APCD) identifies how much commercial health insurance payers and patients pay for the Evaluation and Management (E&M) facility portion of an Emergency Department (ED) visit.

ED visits typically include an E&M facility component that corresponds to the severity level of the visit – ranked from low to high. In 2018, the median statewide facility payment for a low severity level visit was approximately $290, and high severity level claims were paid at nearly $3,000. These payments only represent a portion of what is billed for an ED visit and do not include amounts for other services which may be performed during the visit such as lab tests, imaging services, surgical procedures, or other fees that may be billed directly by the ED physician or provider.

Payments for each individual severity level code also vary statewide as is typical of prices for other common health care services analyzed with data in the CO APCD. For example, the most common range of payments (25th to 75th percentile) for the highest severity code was $1,990-$4,700, yet the highest facility payment for the same severity level in 2018 was nearly $48,000.

In a related Data Byte released in 2017, between 2009-2016, there was an increase in the percentage of all ED visits in Colorado being coded at the highest severity level, and a decrease in all other severity levels across commercial payers.

Patients, providers and others can use this information to understand how their bills and prices compare to statewide information and identify ways to reduce ED visit cost variation across the state.

To view more Data Bytes and analyses, visit https://www.civhc.org/get-data/publications/. To search prices for common health care procedures by named facility, visit the Shop for Care page of the CIVHC website.

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Categories: CO APCDNews