Medicare Provider & Procedure Cost Lookup

Look up Medicare procedure costs, national average CMS fee schedules, 20% coinsurance responsibilities, and facility vs office cost comparisons.

Procedure Name or CPT / HCPCS Code

Specialty Category

Care Setting

Common Outpatient Procedures:

CPT 66984 Ophthalmology Medicare Part B

Extracapsular Cataract Removal with IOL Insertion

Removal of clouded crystalline lens using phacoemulsification ultrasound probe, followed by implantation of an artificial intraocular lens prosthesis in one eye.

Total Medicare Allowed Amount $1,894.00 Ambulatory Surgery Center

Medicare Pays (Approx. 80%) $1,515.20 Federal Part B reimbursement

Patient Coinsurance (20%) $378.80 If annual Part B deductible met

Facility Setting Cost Comparison

Medicare reimburses different rates depending on whether the procedure is performed in an independent Ambulatory Surgical Center (ASC) or a Hospital Outpatient Department (HOPD).

Facility Setting	Facility Fee	Doctor Fee	Total Allowed	Your 20% Copay
Ambulatory Surgery Center (ASC)	$1,328.00	$566.00	$1,894.00	$378.80
Hospital Outpatient Dept (HOPD)	$2,280.00	$566.00	$2,846.00	$569.20
Doctor's Office (In-Clinic)	N/A	$680.00	$680.00	$136.00

CMS Billing & Coverage Specifications

Global Surgery Period: 90 Days (Major Surgery)

Prior Authorization: Not typically required for traditional Part B

Bilateral Billing Rule: 150% Payment adjustment applies with Modifier 50

Typical Anesthesia: Monitored Anesthesia Care (MAC) or Topical

Out-of-Pocket Cost Estimator

Calculate your real out-of-pocket payment based on your supplemental coverage:

Supplemental / Medigap Plan

2026 Part B Deductible ($257)

Deductible Already Met Deductible Unmet (Pay up to $257)

Physician Assignment Status

Participating (Accepts Assignment) Non-Participating (Up to 15% Excess)

Medicare 20% Coinsurance: $378.80

Medigap Pays: -$378.80

Remaining Deductible: $0.00

Estimated Out-of-Pocket: $0.00

With Plan G and your deductible met, your out-of-pocket cost for this procedure is $0.00!

Important Patient Rights

Assignment Protection: Doctors who accept Medicare assignment agree by law not to bill you more than the Medicare-approved amount.
Limiting Charge: Non-participating doctors may only charge up to 15% above the non-participating Medicare allowable rate.
Advance Notice: If Medicare may not cover a procedure, facilities must issue an Advance Beneficiary Notice (ABN) in advance.

Matching Procedures (10)

About this tool

How to use it

Enter a CPT procedure code (such as 66984, 45378, 27447) or browse by specialty category.
Toggle between Ambulatory Surgery Center (ASC), Hospital Outpatient (HOPD), and Office care settings.
Review Medicare allowable fee schedules, federal 80% contribution, and patient 20% coinsurance liability.
Select your Medigap policy (Plan G, Plan N) and deductible status to calculate precise out-of-pocket expenses.

Why it matters

Medicare procedure billing is notoriously complex, with facility charges differing drastically between hospital outpatient departments and independent ambulatory surgery centers. This lookup lets patients compare official allowable fees and plan for coinsurance obligations in advance.

When to use it

Use when anticipating upcoming surgeries, diagnostic scopes, or radiology tests, verifying provider participation assignment, or estimating out-of-pocket medical expenses under Medicare.

Common questions

What is the difference between an ASC and HOPD Medicare fee?

Ambulatory Surgical Centers (ASCs) are independent outpatient facilities that typically bill Medicare significantly less for facility overhead than Hospital Outpatient Departments (HOPD), resulting in lower 20% patient coinsurance.

Does Medicare Part B cover 100% of procedure costs?

No. Traditional Medicare Part B covers 80% of the Medicare-approved allowable amount once the annual deductible is met. The beneficiary is responsible for the remaining 20% coinsurance unless covered by a Medigap policy.

What is a Medicare assignment agreement?

A participating Medicare physician accepts assignment, meaning they agree by law to accept the CMS fee schedule as payment in full and cannot balance-bill the patient above the standard 20% coinsurance.