Shoppable Services (Hospital)
Hospitals must publish all core and ancillary charges associated with 300 Shoppable Services. Shoppable Services are any service that can be planned in advance, thus allowing patients to shop around before scheduling an appointment. The charges must be posted in a consumer-friendly format.
Of the 300 Shoppable Services, 70 are pre-determined by The Centers for Medicare and Medicaid Services (CMS), and the remaining 230 are self-selected by each hospital.
Hospitals that already employ a patient-facing estimation tool are exempt if the tool meets the following requirements:
- Patients can access out-of-pocket cost estimates
- Estimates are available for all 300 Shoppable Services
- The estimation tool is prominently displayed on the hospital’s website and has no barriers to access like logins or needing to input patient information before seeing prices
The Centers for Medicare and Medicaid Services (CMS) 70 Shoppable Services
| Medicine and surgery services | 2020 CPT/HCPCS/DRG primary code |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities | 216 |
| Spinal fusion except cervical without major comorbid conditions or complications (MCC) | 460 |
| Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC) | 470 |
| Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC) | 473 |
| Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) | 743 |
| Removal of 1 or more breast growth, open procedure | 19120 |
| Shaving of shoulder bone using an endoscope | 29826 |
| Removal of one knee cartilage using an endoscope | 29881 |
| Removal of tonsils and adenoid glands patient younger than age 12 | 42820 |
| Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 43235 |
| Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 43239 |
| Diagnostic examination of large bowel using an endoscope | 45378 |
| Biopsy of large bowel using an endoscope | 45380 |
| Removal of polyps or growths of large bowel using an endoscope | 45385 |
| Ultrasound examination of lower large bowel using an endoscope | 45391 |
| Removal of gallbladder using an endoscope | 47562 |
| Repair of groin hernia patient age 5 years or older | 49505 |
| Biopsy of prostate gland | 55700 |
| Surgical removal of prostate and surrounding lymph nodes using an endoscope | 55866 |
| Routine obstetric care for vaginal delivery, including pre-and post-delivery care | 59400 |
| Routine obstetric care for cesarean delivery, including pre-and post-delivery care | 59510 |
| Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care | 59610 |
| Injection of substance into spinal canal of lower back or sacrum using imaging guidance | 62322-62323 |
| Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance | 64483 |
| Removal of recurring cataract in lens capsule using laser | 66821 |
| Removal of cataract with insertion of lens | 66984 |
| Electrocardiogram, routine, with interpretation and report | 93000 |
| Insertion of catheter into left heart for diagnosis | 93452 |
| Sleep study | 95810 |
| Physical therapy, therapeutic exercise | 97110 |