Opn insj/rplcmt ins ptn subq
Open insulin pump insertion or replacement procedures cost between $19,839 and $21,444 depending on whether you receive care at an ambulatory surgery center versus hospital outpatient facility, making it essential to verify your billing location before treatment.
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
This procedure involves surgically placing a new insulin pump device under the skin or replacing an existing one. Patients with Type 1 diabetes or insulin-dependent Type 2 diabetes typically receive this treatment when starting pump therapy or when their current device needs replacement. Code 0816T is a Category III CPT code, meaning it's temporary and used for emerging technologies, which can result in varied reimbursement rates across different payers.
Non-facility rate
$99
Office setting benchmark
Data sources
4
23 data points
Key insights for CPT 0816T
ASC vs hospital outpatient savings
$1,605Having this done at an ambulatory surgery center costs $19,839 vs $21,444 at a hospital outpatient
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $21,444 | +21561% |
| Ambulatory surgery (ASC) | $19,839 | +19940% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use