Price Variation in Outpatient Percutaneous Coronary Intervention

Kriyana P. Reddy; Navneeth Murali; Nicholas K. Smith; Sameed Ahmed M. Khatana; Paula Chatterjee; Alexander C. Fanaroff; Peter W. Groeneveld; Jay S. Giri; Ashwin S. Nathan

doi:10.1161/circulationaha.126.081539

October 26, 2026Circulation

Price Variation in Outpatient Percutaneous Coronary Intervention

View at Publisher

Ask AI

Bookmark

Share

Figures

Why the study?

Does performing outpatient percutaneous coronary intervention in ambulatory surgical centers reduce negotiated commercial and Medicare prices compared to hospital outpatient departments among US outpatient facilities?

Key Points

To evaluate and compare price variation for outpatient percutaneous coronary intervention between hospital outpatient departments and ambulatory surgical centers using national price transparency data.
Analyzed 44 871 prices for Current Procedural Terminology code 92928 across 8486 outpatient facilities between April 1, 2025, and July 31, 2025, using standardized Turquoise Health data.
Categorized facilities as hospital outpatient departments (HOPDs) or ambulatory surgical centers (ASCs) and assessed within-facility and across-facility commercial and Medicare price variation.
Evaluated commercial price differences using a generalized linear mixed-effects model with hospital referral region clustering, adjusting for Census region, metropolitan status, and market concentration.
Commercial prices varied widely with an overall median of $4149 (IQR, $980–$11 460), whereas Medicare prices were more uniform with a median of $10 787 (IQR, $7103–$11 382).
Within-facility commercial price variation was significantly higher in HOPDs than ASCs, showing median maximum-to-minimum price ratios of 6.27 versus 2.21 (P < 0.001).
In the adjusted model, ASCs had 26% lower median commercial prices than HOPDs (rate ratio, 0.74 [95% CI, 0.7–0.78]; P < 0.001), and micropolitan facilities had lower prices than metropolitan sites (rate ratio, 0.39 [95% CI, 0.17–0.92]; P = 0.032).

Structured PICO

Does performing outpatient percutaneous coronary intervention in ambulatory surgical centers reduce negotiated commercial and Medicare prices compared to hospital outpatient departments among US outpatient facilities?

P

Population

8,486 US outpatient facilities (hospital outpatient departments [HOPDs] and ambulatory surgical centers [ASCs]) reporting 44,871 prices (36,285 commercial and 8,586 Medicare prices) for outpatient percutaneous coronary intervention (CPT code 92928) between April 1, 2025, and July 31, 2025. Key inclusion: facilities with ≥1 commercial and ≥1 Medicare price.

I

Intervention

Outpatient percutaneous coronary intervention (CPT code 92928) performed in ambulatory surgical centers (ASCs)

C

Comparator

Outpatient percutaneous coronary intervention (CPT code 92928) performed in hospital outpatient departments (HOPDs)

O

Outcome

Price differences and variation in negotiated commercial and Medicare prices for CPT code 92928 between HOPDs and ASCs, including within-facility maximum-to-minimum commercial price ratios, across-facility HOPD-to-ASC median price ratios within hospital referral regions, and adjusted median commercial price differences.

Limitations

Price transparency data may incompletely capture facilities performing PCI because of variable compliance with federal reporting requirements and heterogeneous reporting practices.
Some extreme commercial prices may reflect differences in contract structure or reporting rather than true reimbursement differences, and commercial contracts may differ in bundling of device-related costs.
Analyses were limited to Current Procedural Terminology code 92928 and findings may not generalize to other PCI procedures.
Posted prices do not capture professional fees or full episode-level reimbursement.
Could not account for differences in case mix, procedural acuity, or facility PCI volume between ASCs and HOPDs.

Implication

Ambulatory surgical centers have 26% lower negotiated commercial prices and substantially less within-facility price variation for outpatient percutaneous coronary intervention compared to hospital outpatient departments, informing potential site-neutral payment reforms.

Abstract

No abstract yet. The journal hasn't published one we can show.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Reddy et al. (2026) studied this question.

synapsesocial.com/papers/6ae0e052bf977a4c72d3050e https://doi.org/10.1161/circulationaha.126.081539

View at Publisher

Ask AI

Bookmark

Share

Price Variation in Outpatient Percutaneous Coronary Intervention

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Price Variation in Outpatient Percutaneous Coronary Intervention

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More from Circulation

Keep reading

More from Circulation