The average price for an inpatient knee replacement is $30,249, compared to $19,002 in an outpatient setting. The report, based on independent Blue Cross and Blue Shield (BCBS) companies’ claims data, shows that prices for identical procedures can … Total spending amounts were extrapolated from the study population to the entire adult BCBS commercially insured population in 2017 and are adjusted for membership growth in prior years. However, the procedure could cost as little as $11,327 in Birmingham, Alabama, and as much as $73,987 in Boston, Massachusetts2, which had the greatest variance within a market, with costs as low as $17,910 (313 percent cost variation). To access your member services, please visit your BCBS company. Data-driven insights to improve the health of all Americans. 8. The cartilage acts as a shock absorber. BCBS companies offer an array of transparency tools that provide standardized healthcare cost and quality information (including cost estimates, practitioner quality information and access to patient reviews) enabling consumers to comparison shop for hundreds of common treatments and procedures. MACI is also not indicated for use in patients who have undergone prior knee surgery in the past 6 months, excluding surgery to procure a biopsy or a concomitant procedure to prepare the knee for a MACI implant. Blue Cross Blue Shield of Massachusetts also offers insurance, pharmacy coverage, and Medicare Plans for seniors; life and disability insurance through Indigo Insurance Services (a wholly owned subsidiary); and insurance for individuals aged 18-26 years. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Blue Cross Blue Shield is unlikely to cover the costs of male breast reduction. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Moreover, outpatient complication rates have substantially improved by 23 percent for knee procedures and 36 percent for hip procedures from 2013 to 2017 and are lower than complication rates in the inpatient setting. Psychotherapy is not required for gender reassignment services except when a mental health professional recommends psychotherapy based on initial assessment prior to gender reassignment surgery. Many Americans are not receiving covered, preventive services. File Name: gender_affirmation_surgery_and_hormone_therapy 7/2011 . 3/2021 . We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter. CHICAGO – The cost of knee and hip replacement surgeries—among the fastest growing medical treatments in the U.S.—varies widely in markets across the country, with extreme variations emerging even within the same market area, according to a report by the Blue Cross Blue Shield Association (BCBSA) and Blue Health Intelligence (BHI). Prices for specific elective procedures are measured in two ways. Cartistem®, a combination of human umbilical cord blood-derived mesenchymal stem cells and sodium hyaluronate, is intended to be used as a single-dose therapeutic agent for cartilage regeneration in Within Dallas, the highest price of a hip replacement is nearly four-times higher than that for the lowest priced procedure. In Dallas, Texas, a total knee replacement could cost between $16,772 and $61,585 (267 percent cost variation) depending on the hospital. Price at national, state and MSA levels are representative of an entire episode of care and include any tests or treatment in the year prior to surgery, the surgical procedure, device and professional fees and any physical therapy or prescriptions in the 60 days after surgery. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. To help consumers identify high quality, affordable hospitals, BCBS companies created the Blue Distinction® Centers+ designation, which recognizes hospitals that demonstrate expertise in delivering patient care safely and effectively, and are also 20 percent or more cost-efficient than non-designated facilities. These are the femur, tibia, and patella. Watch the full episode. Magnetic Resonance Imaging (MRI) of Neck, Face, Orbit. Cost transparency is key for patients to work with their doctor to compare and consider the best setting of care (whether inpatient or outpatient) and specific facility for these planned procedures. CODING BlueCHiP for Medicare and Commercial Medical Coverage Policy | Knee Walker. An Independent Licensee of the Blue Cross and Blue Shield Association Computer Assisted Surgical Navigational Orthopedic Procedures Not applicable. About BHI Gender Affirmation Surgery and Hormone Therapy . The data also limits scope of episodes it will measure in order to ensure comparability, creating a "normal" cohort. Episode costs are based on total amount of procedure and ancillary costs for a period of time pre and post procedure. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Wide price variation continues to exist for orthopedic procedures across the U.S.14 In 2017, the national average price for a complete episode of orthopedic care was about $34,000, with average costs of $34,513 for inpatient knee replacements and $34,282 for inpatient hip replacements.15,16, Between MSAs, prices range three-fold—from an average low price of $19,934 and $19,263 for knee and hip procedures in Des Moines, Iowa, to an average high price of $61,750 and $64,641 for knee and hip surgeries in New York, N.Y.17 (See Appendices A, B and C for more information on costs by state and MSA.). The cost transparency section includes only episodes of care pricing at inpatient facilities due to low reporting volume for the outpatient setting. An Independent Licensee of the Blue Cross and Blue Shield Association. When Computer Assisted Surgical Navigational Orthopedic Procedures are not covered Computer -assisted surgery for orthopedic procedures of the pelvis … It is likely that yours is too. Episodes were dropped from the data where applicable, for patient age (65), complicating conditions (cancer, HIV) and other criteria. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association page 1 of 6 Revised 12/2008 A resource: Services for which predeterminations can be requested: This is not an all inclusive list. This report is based on analysis of data from BCBS Axis, the largest collection of commercial insurance claims data in the U.S. BCBS Axis was completed in 2015 to support cost transparency and data-driven decision making. There is wide price variation for knee and hip procedures within and between metropolitan statistical areas (MSAs). For more information, visit: http://www2.census.gov/geo/maps/metroarea/stcbsa_pg/Feb2013/cbsa2013_MA.pdf. The Blue Cross and Blue Shield Association is a national federation of 35 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. In 2011 there were 645,062 typical hip replacements and 306,600 typical knee replacements performed in the U.S., according to a report from the American Academy of Orthopaedic Surgeons. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Excellus BCBS is using an evidence-based approach to treat back pain, improving outcomes and dramatically reducing costs. Between Des Moines, Iowa, and New York, N.Y., knee and hip procedure prices vary more than three-fold. In response to these trends, BCBS companies developed solutions to help inform and empower individuals to select quality, affordable sites of care that best meet their needs. BCBS companies established Blue Distinction® Centers+, a national designation program recognizing healthcare facilities that demonstrate expertise in specific types of care—safely, effectively and cost-efficiently. The discs are laser etched or … In the same time span, knee and hip replacement rates have increased 17 and 33 percent, respectively.5. For more information on BCBSA and its member companies, please visit BCBS.com. Quality Care That’s Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Over 550 Blue Distinction Center+ for knee and hip replacement have been designated across the country to help Americans make informed choices about quality, cost-effective care. Origination: Last CAP Review: Next CAP Review: Last Review: … Total knee and hip replacements performed in Blue Distinction Center+ facilities offer 24 percent savings (across the episode of care) when compared to non-Blue Distinction Center+ facilities. However, it could cost as little as $11,317 in Montgomery, Alabama, and as much as $69,654 in New York, New York. BCBS companies have worked with providers to identify Centers of Excellence throughout the country to ensure quality, cost-effective care—known as Blue Distinction® Centers. Learn more about our other insurance plans and … This was done, in part, due to the need to obtain provider level pricing. The cost-variation study is the first report by Blue Cross Blue Shield, The Health of America Report, a collaboration between the BCBSA and BHI that will utilize a market-leading medical claims database to uncover key trends and provide insight into healthcare dynamics. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. The report, based on independent Blue Cross and Blue Shield (BCBS) companies’ claims data, shows that prices for identical procedures can quadruple in cost depending on which hospital a patient chooses within a market. Access to outpatient facilities and the use of outpatient facilities for both knee and hip replacement procedures varies widely from state to state.13 For knee procedures, Alaska, Colorado, Georgia, Hawaii, Indiana, Kentucky, Minnesota, Mississippi and Ohio show outpatient surgery rates above 20 percent. Within the largest 100 MSAs, there is also typically a three- to four-fold difference between the highest priced and lowest priced episode of care (“price spread”) for these surgeries. I have BCBS in CA and mine was covered. How much will that knee surgery cost? To learn more about BCBS initiatives in local communities, see: www.bcbs.com/the-health-of-america, Planned orthopedic surgeries are increasingly common among Americans ages 35 to 64, costing more than $25 billion dollars in 2017—an increase of 44 percent over the past eight years.4 Since 2010, prices increased 6 percent for knee procedures and 5 percent for hip procedures. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. Knee and hip replacement procedures are among the fastest growing medical treatments in the U.S. A study published in the June 2014 issue of Journal of Bone and Joint Surgery, found that the number of typical knee replacements more than tripled and that typical hip replacements doubled between 1993 and 2009. © 2021 Blue Cross Blue Shield Association. Planned knee and hip replacement surgeries are on the rise in the U.S. How the 2020 election will impact healthcare, Upstate New Yorkers may miss preventive care for these surprising reasons, https://www.bcbs.com/about-us/capabilities-initiatives/blue-distinction/blue-distinction-specialty-care#kneehip. Complication rates for knee and hip procedures in the inpatient setting have improved over the past eight years—with rates down 29 percent for knee procedures and 32 percent for hip procedures.6 In addition, the average length of a hospital stay has also decreased for inpatient procedures since 2010. Planned procedures by state (2010, 2017)See Excel document, Appendix C: How is it in terms of trans care? Many surgeons accept Blue Cross. The increase in the number of knee and hip procedures from 2010 to 2017 is the main cost driver, as the number of knee and hip procedures is up across nearly all ages. injuries of the knee, hip, shoulder, spine, hand and wrist, foot and ankle and elbow. Utilization increased by 17 percent for knee replacements and 33 percent for hip replacements. Foot orthotics are considered not medically necessary when the criteria listed above … The recommendation for psychotherapy must specify the goals of treatment along with estimates of the frequency and duration of therapy throughout the individual’s experience living in one’s affirmed gender. To learn more about the Blue Distinction® Program, see: https://www.bcbs.com/about-us/capabilities-initiatives/blue-distinction/blue-distinction-specialty-care#kneehip. In some cases adjacent MSAs were combined to ensure sufficient data. Between the bones of the knees are 2 crescent … The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Prices in South Florida are less than more … As each of these Health of America Reports reveal, utilization and costs of planned knee and hip procedures both continue to rise, impacting overall healthcare costs. As more consumers shop for healthcare, insurance companies must use their data … Refer to the Medical Policy link or … You need to get the billing company that works with your doctor and surgery … supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member. Member Discounts Take advantage of member-only discounts on health-related products and services. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. Medical decisions relative to medical technologies are to be made strictly by members/patients in … Similar trends were also seen for the average typical cost for a total hip replacement procedure, which averaged $30,124. An Independent Licensee of the Blue Cross and Blue Shield Association Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions ProChondrix® (AlloSource) and Cartiform® (Arthrex) are waferthin allografts where the bony - portion of the allograft is reduced. Excellus BlueCross Blue Shield (Excellus BCBS) conducted a survey to find out why. During surgery, you may be under general anesthesia (medicine that puts you to sleep and keeps you from feeling pain during the surgery). In addition, BCBS companies established Blue Distinction Centers+, a distinction available only to facilities that meet both quality and cost thresholds, and BCBS has awarded over 550 designations nationwide for knee and hip replacements. Members have access to consumer transparency tools on their BCBS company’s member portal or at the National Doctor and Hospital Finder. This page explains the coverage requirements, plan types, and covered procedures, as well as how to appeal a denial. This is a smooth material that cushions the bone and allows the joint to move easily without pain. In 2017, the greatest price spread for planned knee replacements occurred in San Antonio, ranging from $22,547 to $88,231 for the same episode of care—more than a three-fold price difference. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. In this report, overall orthopedic care costs include any of the following as they relate to musculoskeletal conditions: office visits, imaging tests, non-surgical treatments, planned surgeries and emergency surgeries. This report identifies trends in cost and quality of care for elective or planned orthopedic surgical procedures (specifically knee and hip replacements) by examining the medical claims of more than 48 million Blue Cross and Blue Shield commercially insured members from 2010 through 2017.18 In this analysis, a knee replacement is defined as a total or partial knee replacement or a revision surgery. Blue Cross launches tool to let customers compare provider prices For more information, visit http://www.bluehealthintelligence.com/. Learn more about our other insurance plans and … A Study of Cost Variations for Knee and Hip Replacement Surgeries in the U.S. http://www2.census.gov/geo/maps/metroarea/stcbsa_pg/Feb2013/cbsa2013_MA.pdf, Blue Cross Blue Shield Association Study Reports Higher Childbirth Complication Rates for Black and Hispanic Women Regardless of Age, Blue Cross Blue Shield Association Announces National Health Equity Strategy to Confront the Nation’s Crisis in Racial Health Disparities, Blue Cross Blue Shield Association Statement on Rise in Violence Against the Asian Community, Blue Cross Blue Shield Association Statement on the Confirmation of Xavier Becerra as Secretary of HHS, Blue Cross Blue Shield Association Partners with Feeding America® and its Network of 200 Food Banks to Drive Education of COVID-19 Vaccination, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas, Blue Cross Blue Shield of Massachusetts and Community Health Centers Begin Offering Free Rides to Boost COVID Vaccine Access. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Among the top MSAs examined in this report, approximately three out of four MSAs have at least one Blue Distinction Center+ for knee and hip replacements (see Appendices C and D). Yet amid the tumult, some things remained unchanged: healthcare once again continued to be a top priority for American voters. “A Study of Cost Variations for Knee and Hip Replacement Surgeries in the U.S.”1 shows the average typical cost (without complications, see footnote) for a total knee replacement procedure was $31,124 in 64 markets where claims data was reviewed. However, an orthotic would be covered for the treatment of the initial, acute, sports-related injury. At the same time, prices for both knee and hip procedures continue to rise year-over-year.7, Complication rates for knee and hip procedures have also improved in the outpatient setting and, in fact, are below rates in the inpatient setting. 2 Data was analyzed based on Metropolitan Service Areas (MSAs) in accordance with Census data, which can include large population areas that may cross state lines. However, both procedures also grew among most of the younger age groups. Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. Despite these potential savings, only 11 percent of knee procedures and 8 percent of hip procedures were performed on an outpatient basis in 2017. This report analyzed three years of independent Blue Cross and Blue Shield (BCBS) companies’ claims data for typical knee and hip replacement surgeries to further assess cost variations across the U.S. Planned knee and hip replacements are becoming more common among Americans, including people under age 55. The report was done in partnership with HealthCore, a wholly owned and independently operated health outcomes subsidiary of Anthem, Inc.
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