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Outpatient care facilities like ambulatory surgery centers (ASCs) are in the spotlight for patients, regulators, and care providers due to their accessibility and affordability. ASCs offer an alternative for patients that require routine procedures and are in relatively good health, allowing them to recover at home rather than in a hospital.

The increasing popularity of outpatient surgery centers led the Centers for Medicare and Medicaid Services (CMS) to reassess whether total joint replacement surgeries are safe to perform in an outpatient setting. In the following list, a knee joint revision costs about $7,800 on average in an ASC, while the same knee joint revision costs an average of $9,100 in an inpatient setting.

Some of the most commonly performed procedures at ASCs include heart monitor and pacemaker implants, as well as the insertion of spinal nerve stimulators. Twelve of the top 25 procedures involve the implant of a heart or spinal cord stimulator. Other common procedures include prosthesis implants, bone fracture treatments, and spinal stenosis treatments.

According to Definitive Healthcare data, the combined charges of the 50 most expensive ASC procedures totaled over $556,000 in 2016. The average charge per procedure was approximately $11,000.

 

Top 50 Most Expensive Procedures at ASCs

  Description CPT/HCPCS Code Charge per Procedure Number of Procedures Total Charges

1.

Implant cochlear device

69930

$28,498

223

$6,355,122

2.

Insert/rplcmt of permanent inflatable defib. w/ transvenous leads

33249

$28,345

310

$8,786,863

3.

Remv & rplcmt defib w/replacement pacemaker

33264

$26,255

237

$6,222,399

4.

Implant spinal cord stimulator

61886

$21,144

41

$866,907

5.

Insert/rplcmt of spinal neurostim

63685

$20,110

6,394

$128,583,703

6.

Generator, neurostim, high frequency, with rechargeable battery

C1822

$19,987

639

$12,771,679

7.

Remv & rplcmt of pulse generator, 1 lead

33262

$19,897

37

$736,194

8.

Remv & rplcmt of defib, dual lead

33263

$19,821

159

$3,151,610

9.

Insert of ocular telescope prosthesis

0308T

$18,085

16

$289,356

10.

Implant neuroelectrodes

63655

$14,500

906

$13,136,697

11.

Insert/rplcmt peripjeral/gastric neurostim

64590

$14,382

3,161

$45,461,006

12.

Insrt/rplcmt cranial neurostim pulse gen

61885

$14,269

94

$1,341,286

13.

Remv & replc of pacemaker, mult leads

33229

$13,872

74

$1,026,505

14.

Implant spine infusion pump, non-programmable

62361

$13,368

16

$213,884

15.

Implant spine infusion pump, programmable

62362

$12,937

1,278

$16,533,126

16.

Insert multi-component penis prosthesis

54405

$11,626

440

$5,115,482

17.

Insertion of inflatable urethral/bladder neck sphincter

53445

$11,618

42

$487,965

18.

Remove/replace penis prosthesis

54410

$11,329

80

$906,348

19.

Remove/replace urethral sphincter

53447

$11,089

24

$266,134

20.

Endovascular revascularization

37227

$10,064

33

$332,113

21.

Arthrodesis sacroiliac joint (pelvis & hip)

27279

$8,922

58

$517,453

22.

Neck spine fusion

22554

$8,526

17

$144,942

23.

Insert heart pacemaker, atrial

33206

$8,333

12

$99,999

24.

Reconstruct head of radius

24366

$8,153

38

$309,816

25.

Insert heart pacemaker, atrial & ventricular

33208

$8,027

579

$4,647,866

26.

Remv & rplcmt pacemaker pulse gen, dual lead

33228

$7,983

585

$4,669,867

27.

Insert heart pacemaker ventricular

33207

$7,974

78

$621,960

28.

Revision of knee joint

27446

$7,891

1,958

$15,450,371

29.

Insert pulse gen, dual leads

33213

$7,791

16

$124,662

30.

Neck spine fuse & remov c2 cervical disc

22551

$7,789

539

$4,198,207

31.

Fusion of foot bones

28735

$7,754

23

$178,352

32.

Treat humerus fracture

24546

$7,754

18

$139,571

33.

Implant temple bone w/stimul

69714

$7,701

174

$1,339,991

34.

Replace elbow joint

24363

$7,699

11

$84,684

35.

Treat humerus fracture

24545

$7,639

28

$213,892

36.

Fusion of foot bones

28715

$7,590

88

$667,911

37.

Fusion of ankle joint open

27870

$7,552

105

$792,944

38.

Revise kneecap with implant

27438

$7,387

57

$421,060

39.

Open/percutaneous placement of stent

37238

$6,716

43

$288,783

40.

Insert spine infusion device

62360

$6,668

15

$100,013

41.

Insert 1 electrode pacemaker-defib

33216

$6,213

15

$93,190

42.

Implant patient-activated ardiac event recorder

33282

$6,208

653

$4,053,935

43.

Remv & rplcmt pacemaker gen single

33227

$6,051

93

$562,757

44.

Insrt of interlaminar stabilization dev

22868

$5,982

31

$185,441

45.

Insrt of interlaminar stabilization dev w/o decompression

22869

$5,958

31

$184,701

46.

Removal of pacemaker gen

33233

$5,952

60

$357,106

47.

Insert semi-rigid penile prosthesis

54400

$5,948

17

$101,114

48.

Male sling procedure, urethra

53440

$5,940

67

$397,978

49.

Endovascular recatheterization, open

37226

$5,743

22

$126,336

50.

Prostate proced, unclassified

55873

$5,617

121

$679,614

Fig 1. Data from Definitive Healthcare based on the 2016 Medicare Ambulatory Surgery Center Limited Data Set (LDS) (1/1/2016-12/31/2016). Calendar Year 2017 data is projected to be released in early 2019 by the Centers for Medicare and Medicaid Services (CMS).