Rectal Control System For Vaginal Insertion, For Long Term Use, Includes Pump And All Supplies And Accessories, Any Type Each

What the Data Says About Rectal Control System For Vaginal Insertion, For Long Term Use, Includes Pump And All Supplies And Accessories, Any Type Each

Across 0 states with reporting providers, CPT code A4563 (Rectal Control System For Vaginal Insertion, For Long Term Use, Includes Pump And All Supplies And Accessories, Any Type Each) shows a national average Medicare payment of $1,039.59 against an average billed charge of $2,927.35. That gap — a 2.8x markup, or 182% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Medical Supplies procedures like this one saw 17 services billed to Medicare in 2023 by 12 distinct providers, serving 15 unique beneficiaries. Regional variation is limited in the underlying CMS file. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Medical Supplies category (2.24x), the estimated commercial insurance price lands near $2,922.72, with self-pay cash discounts commonly bringing the figure closer to $1,783.61. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.