Table 3

Unit costs

DescriptionReimbursement codeMedicare paymentCommercial paymentBlended payment* (2018 US$)
ICM device and insertionWeighted average of:
80% outpatient (APC 0680 plus physician fees CPT 33282: $7812 blended payment*), and 20% mean inpatient admission (DRG 260, 261, or 262 in patients with ICD-10 0JH602Z or 0JH632Z or CPT 33282: $18628 blended)
US$9209US$11 511US$9975
ICM explantTotal outpatient (APC 0020) plus physician fees (CPT 33284)US$746.00US$932.50US$808.10
Monthly ICM monitoringMonthly average of one in-person check 1 month after insertion (CPT 93291) and remote checks every month thereafter (CPT 93298+CPT 93299)US$72.18US$90.22US$78.18
Conventional testingWeighted average of 70% inpatient admission (DRG 312 with no ICD code for injuries: US$8296 blended payment*) and 30% outpatient testing: US$2536 blended (table 1)US$6063US$7579US$6568
Cost of medication per monthSee online supplemental filesNANAUS$640
Pacemaker device and implantationTotal outpatient (APC 0655) plus physician fees (CPT 33208)US$9958US$12 448US$10 852
AblationTotal outpatient (APC 8000) plus physician fees (CPT 93656)US$19 693US$24 616US$21 332
Defibrillator device and implantationTotal outpatient (APC 0108) plus physician fees (CPT 33249)US$31 639US$39 549US$34 273
Monthly pacemaker follow-upCPT 93280+1 outpatient consultation every 6 monthsUS$72US$90US$78
Monthly defibrillator follow-upCPT 93289+2 in-person and three remote consultations in the first year, then one in-person and three remote consultations every year after
Monthly medication follow-upCPT 93280+1 outpatient consultation every 6 monthsUS$72US$90US$78
Major injuryMean cost of hospitalisation for any injury-related DRG plus ICD code for syncope (ICD-10 R55 Syncope or ICD-10 I95.1 Orthostatic Hypotension). Top and bottom 1% of data were trimmed to remove outliers. The average cost across the >85th percentile were assumed to represent major injury based on the occurrence of major trauma in Bartoletti et al 2008.19US$31 742US$39 678US$34 385
Minor injuryMean cost of hospitalisation for any injury DRG plus ICD code for syncope (ICD-10 R55 Syncope or ICD-10 I95.1 Orthostatic Hypotension). Top and bottom 1% of data were trimmed to remove outliers. The average cost across the ≤85th percentile were assumed to represent minor injury based on the occurrence of minor trauma in Bartoletti et al 2008.19US$9409US$11 761US$10 192
  • *Payments are based on national average payments, and represent a weighted average between Medicare and commercial paid amounts based on the proportion of patients with syncope covered by Medicare (66%).

  • APC, ambulatory payment classification; CPT, current procedural terminology; DRG, diagnosis-related group; ICD-10, 10th Revision of the International Classification of Diseases; ICM, insertable cardiac monitor; USD, US dollar.