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What is the insurance code for Non Stress Testing? How much do clinics bill insurance to run the Non Stress Test? How many Non Stress Tests are run per year?
Hi! Thank you for your question about the insurance code for Non-Stress Testing, how much do clinics bill insurance to run the Non-Stress Test, and how many Non Stress Tests are run per year.
In short, the CPT code for Fetal Non-Stress Tests is 59025. The average cost of the test is between $48 and $237. The total number of Fetal Non-Stress tests conducted annually in the US can be estimated to be 113,559 tests. I have provided a deep dive of my findings below.
METHODOLOGY
I have mainly focused on the American market because the US holds the biggest share of the fetal monitoring market. As such I was able to find the CPT codes and the price of NST by searching through industry reports and government databases. Unfortunately, after searching extensively through clinics' reports and the annual reports of the biggest insurance companies in the US, the amount billed to insurance companies to run the Non-stress test was not publicly available.
THE CPT CODES AND THE PRICE OF NST
The CPT code for Fetal Non-Stress Tests (NST), provided by Natus and GHC, is estimated to be 59025. Looking through the prices of NST on various medical portals, I was able to get a range of the cost of the test. it costs between $48 and $237 and the average cost is $94. The data used to arrive at these estimates are from Minnesota, Wisconsin, and South Dakota. ClearHealth provides the range of cost from $111 to $217 for the NST. This range is for self-pay uninsured patients.
To triangulate the number of NST conducted per year, I was able to find the number for California and have extrapolated the same for the US. Based on data from OSHIPD, the Emergency Department and Ambulatory Surgery for 2015, the frequency for code 59025 is 6,572 and in Ambulatory Surgery sheet, the frequency is 8,080. That is a total of 14,652 (6572 + 8080) fetal NST in 2015 in California. The pregnancy rate in the US is 98.7 per 1000 women in the age group of 15-44. The total number of women in the age group of 15-44 in California is 8,235,663, while in the US the number is 63.82 million. Assuming the pregnancy rates on average to be the same across the US and California, we can calculate the amount of NST performed every year as follows:
Total number of pregnant women in California: 98.7* 8,253,663 /1000 = 812,859
Total number of pregnant women in US: 98.7 * 63.82 million / 1000 = 6.3 million
Using algebra, 14,652 fetal NST were done by 812,859 pregnant women. Therefore, extending the same for the US, the total number of fetal NST across the US can be estimated to be 14652 * 6.3 million / 812859 = 113, 559 tests annually.
CONCLUSION
To conclude, the CPT code for Fetal Non-Stress Tests is 59025. The average cost of the test is between $48 and $237. The amount billed to insurance companies was not publicly available. The total number of Fetal Non-Stress tests conducted annually in the US can be estimated to be 113,559 tests.
I hope the research is useful. Thank you for using Wonder! Please let us know if we can help with anything else!