what the cardio's office gets paid from medicare

I happened to be on my Medicare site just now looking up what injection the ortho Doctor used on my thumb that lasted a week.  Noticed a new payment , looked it was a charge  for when i was in for my yearly pacemaker check.  Where all is downloaded an then ready to recieve the nightly remote transmissions.  If i had not know would never have realized.  It was called "programming of my dual lead pacemaker". done by the EP, whom i never saw only the pacemaker check gal.  What the heart center got from Medicare was $62.50 and from my medigap policy got was $15.58.

new to pace


UK Private Care

by Penguin - 2023-09-16 16:07:40

A pacing check via private medicine in the UK would cost in the region of £200 plus a consultation with an EP at £250.  That's roughly £550 USD, but you would get a decent amount of time with the pacing technician and approx 30 mins with an EP. 

Not sure how much remote monitoring would cost.

Your costs don't sound too bad!

Submitted Charges vs Medicare Reimbursement

by Marybird - 2023-09-16 17:04:21

I'm sure New To Pace's cardiology office submits significantly higher rates for her in-office device checks/setting changes to Medicare, but Medicare's reimbursement rates are generally a fraction of the cost submitted- often much less than half the submitted amounts. If a practice or provider accepts Medicare assignment, they accept Medicare's payment as payment in full and agree not to bill the patient for the remaining difference in the charges and reimbursement. Traditional Medicare pays 80% of their rate for this service, and the patient ( or a Medigap or secondary insurance) pays the other 20%. In an in-office pacemaker interrogation w/wo setting changes, the office would bill for both the technical ( actual interrogation, setting changes) and the professional component- ie, physician ( EP) review of the findings and report, and signature. 

If I recall, the Medicare reimbursement to my cardiology office for my in-office readings are close to yours, NTP,  though I think the charges they submit are about twice that amount. 





by new to pace.... - 2023-09-16 17:23:18

Yes i think they charged Medicare $129.  In all my in office yearly downloads have not seen the EP nor have any changes been made.  Since i am not dependent on the pacemaker i did not have those jolts that others have mentioned.

new to pace


by Penguin - 2023-09-16 18:37:10

Thank you for explaining how Medicare works to me Marybird.  I understand now. 

NTP - I do think it's odd that you never get to see an EP and no changes have never been made to your pacemaker settings. You get a considerable amount of AF events don't you? Doesn't this merit EP attention or do the techs monitor you? 

I'm not sure what you mean by 'jolts'.  Have you reported them and asked someone to investigate?  




by new to pace.... - 2023-09-16 18:46:28

I do not get jolts.  That is what i thought many have said when they have their pacemaker tested in the office.

My a-fib episodes now i have figured out come from when i have a reactions to some foods.  Most are really short a couple of seconds here an there.  Not since last fall has anyone every contacted me, when i was having a reaction to a supplement i was taking.

I have a quarterly remote transmission on Sept 20th will report after that as to how i am doing. I know am trying my best to stay away from the foods that are causing those d..... A-fib episodes.  It has been hard trying to avoid everything.  That said am really going to cheat on my birthday.

new to pace


by Penguin - 2023-09-16 19:14:44

Apologies for the misunderstanding re jolts.

You said, 'I have had those jolts that others have mentioned'. 

That confused me a bit. 

The charges

by PacedNRunning - 2023-09-16 19:39:15

Even though you never saw the EP, the cost of the interrogation and him reading the report is what we are charged for. I have these monthly and charged monthly.  Mine are $13 a month after I hit my deductible, before I hit my deductible it's about $50. The MD bills $80.

charges and no jolts

by new to pace.... - 2023-09-16 20:01:20

thanks Penguin for pointing the jolts out to be, i corrected the sentence to read no jolts. 

I asked the tech for the log events and the summary which she gave me on right there, without the EP's electronic signature. 

new to pace                                                                       

HMO Costs

by Stache - 2023-09-17 14:58:58

I have Kaiser Permanente HMO here in Northern California which monitors my dual chamber heart pacer.  I don't use Medicare and Kaiser bills me between $30 and $60 for a in-clinic pacer check or adjustment and of course my co-payment of $30.  I just consider it a necessary evil to ensure my pacer is working correctly.  The medical cost and pricing are really unknown and I am always billed after the clinic visit.  I have no idea how Kaiser charges for each visit and I have never had a straight answer as to how it works.


by new to pace.... - 2023-09-17 15:27:11

Years back before i had medicare.  One of the doctors did not know what to charge my private health insurance.  She just used what they sent in to Medicare.

new to pace  

who's in charge

by Tracey_E - 2023-09-18 09:18:26

Pacer settings are a prescription written by a doctor, therefore even if you only saw the tech or nurse, the doctor is the name on the submission. In theory, the doctor reviewed the file but realistically when it's routine they probably do not. 

signer of report

by new to pace.... - 2023-09-18 09:31:10

thanks Tracey_E, that is what i thought.

new  to pace

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