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.
0001F · the short answer
For heart failure composite, Medicare pays about $0.38 on average across 2 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $0.38
- Providers bill
- $0.50
- States with data
- 2
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
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), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Other procedures average 2.24x Medicare rates. 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 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 RAND 2024 commercial-to-Medicare ratios specific to the Other category (2.24x), 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.
What to do with this
If you may have heart failure composite done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare heart failure composite costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
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, or report a data error.