Other · 0001F
Heart Failure Composite
What Medicare pays for 0001F, what providers bill, and how the price varies across 2 states, drawn from CMS 2023 claims data.
- $0.38
- Medicare pays
- $0.50
- Providers bill
- 1.3×
- Markup
- #7,950 of 9,297
- Volume rank
The verdict
Heart Failure Composite posts modest national service volume.
- 14th pct.
- national service volume
- $0.38
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Other, the applied ratio is 2.24x Medicare (RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
What the billed charge breaks down into
$0.50
What the Data Says About Heart Failure Composite
Across 2 states with reporting providers, CPT code 0001F (Heart Failure Composite) shows a national average Medicare payment of $0.38 against an average billed charge of $0.50. That gap, a 1.3x markup, or 31% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Other procedures like this one saw 66 services billed to Medicare in 2023 by 8 distinct providers, serving 32 unique beneficiaries. State-level variation is significant: Colorado reports the lowest average payment at $0.01, while Texas reports the highest at $0.04. A 253% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.24x Medicare; RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline), the estimated commercial insurance price lands near $1.10, with self-pay cash discounts commonly bringing the figure closer to $0.50. Within Other, Heart Failure Composite ranks #147 of 151 tracked procedures by national average Medicare payment.
Where this sits in the registry
Heart Failure Composite (0001F) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Other codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Heart Failure Composite rank among Medicare procedures?
According to CMS Medicare Part B claims, Heart Failure Composite (CPT 0001F) ranks #7,950 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #147 of 151 within Other by national average Medicare payment. See /methodology#corpus-placement.
How much does Heart Failure Composite cost?
Heart Failure Composite (CPT 0001F) shows unusually wide state-to-state pricing: Medicare pays $0.38 on average nationally, but the $0.01-$0.04 range across states spans more than double from cheapest to priciest.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Heart Failure Composite cost with insurance?
With commercial insurance, heart failure composite costs an estimated $1.10 on average (range: $0.77-$1.54), a moderate premium over Medicare's $0.38. Without insurance, the estimated cash price is $0.50.
Which state has the lowest cost for Heart Failure Composite?
Colorado has by far the lowest average Medicare payment for Heart Failure Composite at $0.01, while Texas pays more than double at $0.04 - a $0.03 gap.
How many providers perform Heart Failure Composite?
Heart Failure Composite is comparatively uncommon: only 8 providers nationally billed Medicare for it in 2023, serving 32 beneficiaries via 66 total services.
What is the billed-to-Medicare markup for Heart Failure Composite?
Providers bill 1.3x what Medicare pays for Heart Failure Composite - a markup within the typical range at 31% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.