How to Read an Itemized Hospital Bill

Itemized Bill vs. Summary Statement

A summary statement usually shows one total, sometimes with a few broad categories. An itemized bill lists each service, supply, drug and room charge on its own line, typically with a date, a code, a quantity and an amount. That version lets a patient see what was billed. If a statement shows only a single lump sum, an itemized bill is generally the document to ask for.

What Each Column Usually Means

Layouts differ from hospital to hospital, but most itemized bills share the same building blocks:

• Date of service: the day the item or service was provided.
• Description: a short, often abbreviated label, such as a lab test, an imaging study or a room charge.
• Revenue code: a code for the hospital department or type of service, such as pharmacy, laboratory or radiology.
• Procedure code: a CPT or HCPCS code that identifies the specific service or item.
• Units: how many times the item or service was billed.
• Charge: the amount the hospital listed for that line.

Reading across a row, a description can be matched to a code and a quantity, and then to the amount charged.

Revenue Codes, CPT Codes and HCPCS Codes

Hospital bills often list revenue codes for the department or type of service. They suggest where in the hospital a charge came from, but they generally do not describe the exact procedure.

A procedure is usually identified by a CPT code or a HCPCS code. CPT (Current Procedural Terminology) codes are five-character codes maintained by the American Medical Association. HCPCS Level II codes, maintained by CMS, cover items such as supplies, drugs and some services. Our guide to what CPT codes are goes into more detail.

Inpatient hospital stays are often paid by MS-DRG, so an inpatient bill may look different from an outpatient one. If a description or code is unclear, the hospital's billing office is the place to ask what it stands for.

Units and Why They Matter

The units column shows the quantity billed. Depending on the item, a unit might be one lab test, one dose, one hour or one day. Units can reveal a line billed more times than expected, or the same item listed twice. The billing office can explain how a particular item is counted.

Charges, Adjustments and Patient Balance

These terms often cause confusion, because the first number on a bill is rarely the amount owed.

• Charges: the hospital's list prices, also called gross charges. They come from the chargemaster, the hospital's master list of gross charges. See what a chargemaster is for background.
• Adjustments: reductions applied to the charges. These can include a contractual adjustment when an insurer has negotiated a lower rate, a discounted cash price, or a financial assistance write-off.
• Insurance payments: amounts a health plan paid toward the bill, if there is coverage.
• Patient balance: what remains after payments and adjustments, which may include a deductible, copay or coinsurance.

Because insurers pay negotiated rates and many hospitals offer a discounted cash price, a large charge total can shrink considerably once adjustments are applied. A useful check is to find the patient balance line and see whether the adjustments above it add up. The difference between a cash price and an insured rate can also explain why two people see different balances for the same service.

Facility Fees and Separate Professional Bills

An itemized hospital bill generally covers the facility side. Hospitals and hospital outpatient departments can bill a facility fee, while physicians such as surgeons, radiologists and anesthesiologists usually bill a separate professional fee. One visit may therefore produce more than one bill. The prices on Clear Hospital Costs are hospital facility charges taken from the hospitals' own files, not total costs. Our guide to facility fees and professional fees explains how the two fit together.

How to Request an Itemized Bill

Patients can ask the hospital's billing office for an itemized statement, often by phone, through a patient portal or in writing. One way to go about it:

1. Find the account number and dates of service on the statement.
2. Contact the billing office and ask for a full itemized bill with codes, units and charges, not just a summary.
3. Ask whether the bill includes revenue codes and CPT or HCPCS codes, and ask for them if it does not.
4. Note the date, the name of the person spoken with and any reference number.
5. When the bill arrives, compare each line with personal records and any estimate received.

A good faith estimate, if one was given, can be compared with the final bill. Under the No Surprises Act, people who are uninsured or who choose not to use insurance can get a good faith estimate for scheduled services. When the itemized bill from a provider or facility comes to at least $400 more than that estimate, the patient may be able to turn to the patient-provider dispute resolution process, and that step generally has to begin within 120 calendar days of the bill date. Details are in our guide to the good faith estimate and the No Surprises Act.

Questions After Reading the Bill

Once an itemized bill is in hand, some people call the billing office about unclear lines or to ask about a correction. Others look into hospital financial assistance or read about negotiating a hospital bill. Nonprofit hospitals must meet IRS section 501(r) requirements, including a written financial assistance policy, though each hospital sets its own eligibility rules.

To see how a bill compares with posted prices, browse hospital prices in Texas or Florida, which show gross charges, cash prices and insurer negotiated rates by hospital. For imaging, local pages such as MRI prices in Houston or CT scan prices in Miami and Fort Lauderdale show how posted facility charges can differ between hospitals.