Price Transparency and Compliance With Federal Regulation for Pediatric Tonsillectomy

Otolaryngol Head Neck Surg. 2022 Aug;167(2):248-252. doi: 10.1177/01945998211047146. Epub 2021 Sep 21.


Objective: To improve hospital price transparency, the Centers for Medicare & Medicaid Services (CMS) requires, as of January 2021, that all hospitals reveal charges for specific items and services. This analysis investigates whether otolaryngology residency-affiliated hospitals have complied with this new regulation, and it evaluates the variability in hospital-reported charges for pediatric tonsillectomy.

Study design: Cross-sectional analysis.

Settings: Subset of hospitals affiliated with otolaryngology residency programs.

Methods: Hospital websites were searched to determine compliance rates with CMS guidelines by posting a price transparency tool and specific charges for Current Procedural Terminology code 42820 (tonsillectomy and adenoidectomy, <12 years old). Various charges were collected: gross charge, discounted cash price, deidentified minimum and maximum negotiated charges, hospital fees, and physician fees.

Results: Overall 104 unique hospitals were analyzed: 81 (78%) provided pricing data, but only 28 (27%) complied with CMS guidelines. The median reported total gross charge was $13,239 (range, $600-$41,957); deidentified minimum negotiated charge, $9222 (range, $337-$25,164); and deidentified maximum negotiated charge, $17,355 (range, $1002-$54,987). Hospital fees (median, $11,900; range, $2304-$38,831) were consistently higher than physician fees (median, $1827; range, $420-$5063). All estimates included a disclaimer stating that values likely underrepresent true prices.

Conclusion: Hospital compliance with the new regulation remains low, which limits efforts toward improved price transparency. There is wide variability in reported charges for pediatric tonsillectomy and adenoidectomy.

Keywords: cost; otolaryngology; pediatrics; price; public health; tonsillectomy.

MeSH terms

  • Adenoidectomy
  • Aged
  • Child
  • Cross-Sectional Studies
  • Hospital Charges
  • Humans
  • Medicare
  • Tonsillectomy*
  • United States