October 2, 2020

70 CMS-Specified Shoppable Services Required by Price Transparency Ruling

During our recent webinar on Price Transparency, some of our participants asked for a list of the 70 CMS-Specified Shoppable Services required in the Price Transparency ruling by the HHS. We have extracted this information from the HHS documentation on the ruling for your convenience.

We were also asked what hospitals should do if they provide less than 300 services.

As a reminder, the ruling indicates that Hospitals must display payer-specific negotiated charges, de-identified minimum and maximum negotiated charges, and discounted cash prices for at least 300 shoppable services, including 70 CMS-specified shoppable services and 230 hospital-selected shoppable services.

  • If a hospital provides less than 300 shoppable services, the hospital should include as many shoppable services as they do provide.
  • If a hospital does not provide one or some of the 70 CMS-specified services listed below, the hospital is to indicate that the service is not offered by the hospital and select additional shoppable services so that the total number is at least 300.
Evaluation & Management Services

2020 CPT/HCPCS Primary Code

Psychotherapy, 30 min

90832

Psychotherapy, 45 min

90834

Psychotherapy, 60 min

90837

Family psychotherapy, not including patient, 50 min

90846

Family psychotherapy, including patient, 50 min

90847

Group psychotherapy

90853

New patient office or other outpatient visit, typically 30 min

99203

New patient office of other outpatient visit, typically 45 min

99204

New patient office of other outpatient visit, typically 60 min

99205

Patient office consultation, typically 40 min

99243

Patient office consultation, typically 60 min

99244

Initial new patient preventive medicine evaluation (18-39 years)

99385

Initial new patient preventive medicine evaluation (40-64 years)

99386

Laboratory & Pathology Services

2020 CPT/HCPCS Primary Code

Basic metabolic panel

80048

Blood test, comprehensive group of blood chemicals

80053

Obstetric blood test panel

80055

Blood test, lipids (cholesterol and triglycerides)

80061

Kidney function panel test

80069

Liver function blood test panel

80076

Manual urinalysis test with examination using microscope

81000 or 81001

Automated urinalysis test

81002 or 81003

PSA (prostate specific antigen)

84153-84154

Blood test, thyroid stimulating hormone (TSH)

84443

Complete blood cell count, with differential white blood cells, automated

85025

Complete blood count, automated

85027

Blood test, clotting time

85610

Coagulation assessment blood test

85730

Radiology Services

2020 CPT/HCPCS Primary Code

CT scan, head or brain, without contrast

70450

MRI scan of brain before and after contrast

70553

X-Ray, lower back, minimum four views

72110

MRI scan of lower spinal canal

72148

CT scan, pelvis, with contrast

72193

MRI scan of leg joint

73721

CT scan of abdomen and pelvis with contrast

74177

Ultrasound of abdomen

76700

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus

76805

Ultrasound pelvis through vagina

76830

Mammography of one breast

77065

Mammography of both breasts

77066

Mammography, screening, bilateral

77067

Medicine and Surgery Services

2020 CPT/HCPCS/DRG Primary Code

Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities

216

Spinal fusion except cervical without major comorbid conditions or complications (MCC)

460

Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).

470

Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).

473

Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)

743

Removal of 1 or more breast growth, open procedure

19120

Shaving of shoulder bone using an endoscope

29826

Removal of one knee cartilage using an endoscope

29881

Removal of tonsils and adenoid glands patient younger than age 12

42820

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope

43235

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope

43239

Diagnostic examination of large bowel using an endoscope

45378

Biopsy of large bowel using an endoscope

45380

Removal of polyps or growths of large bowel using an endoscope

45385

Ultrasound examination of lower large bowel using an endoscope

45391

Removal of gallbladder using an endoscope

47562

Repair of groin hernia patient age 5 years or older

49505

Biopsy of prostate gland

55700

Surgical removal of prostate and surrounding lymph nodes using an endoscope

55866

Routine obstetric care for vaginal delivery, including pre-and post-delivery care

59400

Routine obstetric care for cesarean delivery, including pre-and post-delivery care

59510

Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care

59610

Injection of substance into spinal canal of lower back or sacrum using imaging guidance

62322-62323

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance

64483

Removal of recurring cataract in lens capsule using laser

66821

Removal of cataract with insertion of lens

66984

Electrocardiogram, routine, with interpretation and report

93000

Insertion of catheter into left heart for diagnosis

93452

Sleep study

95810

Physical therapy, therapeutic exercise

97110

 

(Source: Table 3, Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals to Make Standard Charges Public)

 

We thank you for your engagement during our Price Transparency discussion and invite you to reach out with any additional questions you may have on the HHS ruling and approaching deadline.

During this time of uncertainty, nothing is more important to us than the safety of our customers, patients, consumers, and employees.
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