A new Data Byte from CIVHC analyzing payment information in the Colorado All Payer Claims Database (CO APCD) identifies how much commercial health insurance payers and patients pay for the Evaluation and Management (E&M) facility portion of an Emergency Department (ED) visit.
ED visits typically include an E&M facility component that corresponds to the severity level of the visit – ranked from low to high. In 2018, the median statewide facility payment for a low severity level visit was approximately $290, and high severity level claims were paid at nearly $3,000. These payments only represent a portion of what is billed for an ED visit and do not include amounts for other services which may be performed during the visit such as lab tests, imaging services, surgical procedures, or other fees that may be billed directly by the ED physician or provider.
Payments for each individual severity level code also vary statewide as is typical of prices for other common health care services analyzed with data in the CO APCD. For example, the most common range of payments (25th to 75th percentile) for the highest severity code was $1,990-$4,700, yet the highest facility payment for the same severity level in 2018 was nearly $48,000.
- Colorado Emergency Department Facility Payments and Price Range, Commercial Payers. Colorado All Payer Claims Database, 2018 (PDF)
- Variation in Prices for Common Health Care Services. Colorado All Payer Claims Database Episode-based Procedures (PDF)