29888
Knee Arthroscopy / ACL Repair
Our Work > Good Faith Estimates > Knee Anthropology ACL Repair
Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Knee Arthroscopy/ACL Repair appears on both lists, and there is a standard service package available for it. It is one of the 11 shoppable services cross-mapped from SSP with TIC + Hospital Requirement.
The anterior cruciate ligament (ACL) reconstruction is a surgical tissue graft replacement of the ligament, located in the knee, to restore its function after injury. The ligament may be repaired or reconstructed; whereas the current surgical gold standard is reconstruction, repair may be preferable.
This service package may require substantial post-procedure services not included in this definition; this may include physical therapy and follow-up visits to ensure a proper rehabilitation. Multiple procedures may be performed on the same day, and an optional service estimate for a meniscectomy is provided. Your service utilization may vary for a number of reasons, including your unique clinical profile and where you receive your services.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in other care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 60%
- Free standing ASC: 40%
Item Definitions
Index
Index
this is the fee for the service being defined; note that other codes may be used to define a similar service
Facility Fee
Facility Fee
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
Professional Fee
Professional Fee
these fees are paid to clinicians for the work associated with this service
Optional Fee
Optional Fee
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
Ancillary Service
Ancillary Service
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
| association | base_code | code_type | estimated_charge | item_type | name |
|---|---|---|---|---|---|
| 29888 | CPT | $1,200 | professional_fee | ||
| 0.856 | 01400 | CPT | $800 | professional_fee | Anesthesia for open or arthroscopic procedures on the knee joint |
| 1 | 29888 | CPT | $5,000 | index | Arthroscopically Aided ACL Repair |
| 29881 | $2,300 | optional_fee [facility] | |||
| 29881 | $400 | optional_fee [professional] | |||
| 0.373788206 | 710 | Revenue Code | ancillary_service | Recovery Room | |
| 0.367078404 | 370 | Revenue Code | ancillary_service | Anesthesia | |
| 0.41171601 | 250 | Revenue Code | ancillary_service | Pharmacy | |
| 0.634 | C1713 | HCPCS | $1,700 | facility_fee | Implantable Anchor or Screw |
| 64447 | CPT | $1,000 | facility_fee | Injection(s) of the femoral nerve | |
| 0.59 | 64447 | CPT | $200 | professional_fee | Injection(s) of the femoral nerve |
| 0.689649914 | J0690 | HCPCS | 60 | facility_fee | Cefazolin sodium injection |
| 0.664771366 | J1100 | HCPCS | 33.21 | facility_fee | Dexamethasone sodium phosphate injection |
| 0.735747119 | J3010 | HCPCS | 45.8 | facility_fee | Fentanyl citrate injection |
| 0.383351851 | J1170 | HCPCS | 48.455 | optional_fee [facility] | Hydromorphone injection |
| 0.433283228 | J1885 | HCPCS | 44 | facility_fee | Ketorolac tromethamine injection |
| 0.715138444 | J2250 | HCPCS | 29.28 | facility_fee | Midazolam hydrochloride injection |
| 0.757967889 | J2405 | HCPCS | 43.23 | facility_fee | Ondansetron hydrochloride injection |
| 0.617367057 | J2704 | HCPCS | 50.86 | facility_fee | Propofol injection |
| 0.372197896 | J2795 | HCPCS | $80 | optional_fee [facility] | Ropivacaine hydrochloride injection |
| 0.832080692 | 278 | Revenue Code | ancillary_service | Other implants | |
| 0.396662528 | J7120 | HCPCS | 78 | optional_fee [facility] | Ringers lactate infusion |
| 0.358015816 | 272 | Revenue Code | ancillary_service | Sterile supplies | |
| 0.587 | 76942 | CPT | 680 | professional_fee | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation |
Captured Spending (N=10,000)
| Decile | Base Fee (Facility + Professional) | Base Fee + Optional Fees |
| 1 | 2% | 1% |
| 2 | 1% | 1% |
| 3 | 3% | 1% |
| 4 | 5% | 3% |
| 5 | 6% | 4% |
| 6 | 9% | 6% |
| 7 | 13% | 10% |
| 8 | 15% | 13% |
| 9 | 14% | 14% |
| 10 | 32% | 48% |
Our Work > Good Faith Estimates > Knee Anthropology ACL Repair