Medicare rates are what percent higher in HOPDs than in ASCs?

• A. 70%
• B. 81%
• C. 90%
• D. 100%

Answer: (B)

Medicare pays differently depending on where a procedure is performed, with hospital outpatient departments carrying higher facility-related costs than ambulatory surgical centers. Under the Medicare payment systems, the same outpatient CPT code usually yields a substantially higher rate in a hospital outpatient department than in an ASC because the HOPD rate includes more of the hospital’s facility costs, overhead, and staffing. The commonly cited comparison shows the HOPD rate is about 81% higher than the ASC rate for the same procedure, reflecting those additional costs built into the hospital setting. While exact percentages can vary by code and year, 81% is the standard figure used to illustrate this difference.