Which statement is true about the relationship between HOPD and ASC Medicare rates?

• A. HOPD rates are 81% higher than ASC rates.
• B. ASC rates are 81% higher than HOPD rates.
• C. HOPD rates are 18% higher than ASC rates.
• D. HOPD rates are equal to ASC rates.

Answer: (A)

Medicare pays for the same procedure differently depending on where it’s performed. Hospital outpatient departments carry higher facility charges because of greater overhead, staffing, and shared hospital infrastructure, while ambulatory surgery centers operate with lower overhead and streamlined costs. Because of that, the Medicare rate for the same procedure is typically higher in a hospital outpatient department than in an ASC. A commonly cited comparison is that HOPD rates are about 81% higher than ASC rates, meaning the HOPD rate is roughly 1.81 times the ASC rate. This reflects the general pattern that hospital settings bill more for the same service due to facility-related costs. The other statements imply the ASC would be higher, equal, or only slightly different, which doesn’t align with how Medicare reimbursement generally differs between these two settings.