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Finding my cost of surgery

My goal was to find my cost of surgery.  After having had deviated septum surgery I discovered I had sufficient information to help review the costs of a new surgery I might need to have performed, trabeculectomy, a surgery for glaucoma.

So what is a CPT code?  It is the key to a secret world of medical billing for surgery!  The American Medical Association has developed a coding scheme to accurately identify most surgical procedures and their cost.  CPT is a trademark of the American Medical Association (AMA).  CPT is an acronym for "Current Procedural Terminology™ ".  The "terminology" is also assigned 5 digit numerical code numbers.  Medicare has jumped on this CPT coding scheme and identified what it deems is reasonable payment to a surgeon for a given surgical procedure.  This considers the stress the surgeon is under and even the financial risk the surgeon is taking for a given procedure.  The AMA has consolidated this information into their web site making it easy to find the cost of your surgery.

I have learned, to date, that the information I have located really only addresses the cost of the surgeon himself, and the follow up post operative visits.  I am afraid I will have to learn quite a bit more to determine the outpatient hospitalization costs.  This would include the anesthesiologist, surgical assistants, operating room, preparation, and recovery areas, and other medications, surgical gown, and other miscellaneous overhead.  That is a lot of material to review!

Find your cost of surgery

Use the AMA site to determine CPT (surgery) cost for a given specific surgical procedure as set by Medicare.

The CPT Code Agreement link leads to a web page with a document that you must accept (at the bottom) before you can get into the CPT code database.  Once you have accepted this agreement, you must enter your state, and select a likely surgical city from the list provided.  After that do not forget the "radio buttons" which let you select a CPT code, or a surgical procedure description.  This description could be quite technical.  I am fortunate for my deviated septum surgery cost investigation that I already had CPT codes from the insurance referral form.

CPT Code Agreement

Go to the link above and following my instructions, try the code 30520 for Septoplasty, one procedure done in deviated septum surgery.  My septum surgery involved 8 CPT codes including the follow up.

Remember these codes represent the value that Medicare assigns to a given procedure for your area.  I am sure that Medicare is constantly reviewing these costs.  Your surgeon may certainly charge more (or less), but that is what Medicare will pay.

One readily available source of the codes is used guide books.  You can see the costs of used surgery guides drops drastically over a period of a year or two.  Notice you can purchase a spiral bound edition versus a conventionally bound book (lays flat!).

I hope this helps find your surgery's prices.

Bob

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BHT Created: 11 Aug 2005

BHT Revised: 22 Oct 2016

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