How much does a lumpectomy cost in 2021? | finder.com

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How much does a lumpectomy cost?

Compare payment options and costs for a lumpectomy

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If you're a candidate for a lumpectomy, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for a lumpectomy before scheduling your appointment.

Average cost for a lumpectomy

If you have health insurance and use an in-network doctor, you can expect to pay $9,234 for a lumpectomy on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $18,817.

Average costs are based on the primary cost of a lumpectomy in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.

CPT code Procedure ZIP used Description In network total costs Out of network total costs
19120 Lumpectomy 90201 Removal of 1 or more breast growth, open procedure $9,234 $18,817

Related costs for a lumpectomy

CPT code Primary procedure Description In network cost Out of network cost
19120 Hospital (outpatient) Hospital outpatient facility (HOSPF) estimate for procedure code 19120 (in addition to your doctor's fee) $6,186 $11,672
Total primary & related costs $6,186 $11,672

Does health insurance cover a lumpectomy?

Most health insurance policies cover a lumpectomy if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of a lumpectomy out of pocket. The exact amount your insurance pays for a lumpectomy comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking a lumpectomy.

Does Medicare cover a lumpectomy?

It depends on your Medicare plan, but generally Medicare covers procedures like a lumpectomy that are considered medically necessary by your doctor.

  • Medicare Part A (Hospital Insurance) covers inpatient care in a hospital or skilled nursing facility following a hospital stay, so it typically won't cover a lumpectomy.
  • Medicare Part B (Medical Insurance) pays for emergency, urgent and outpatient care and some preventative services, which means Medicare likely covers a lumpectomy — but you'll be charged a 20% coinsurance.
  • Medicare Part C (Medicare Advantage) is a comprehensive plan that combines Part A, Part B and often Part D and should pay for a portion of a lumpectomy minus any deductible, copay or coinsurance.
  • Medicare Part D (Prescription Drugs) won't cover a lumpectomy, but it may help to pay for any medication you need as part of your recovery.

What affects the cost of a lumpectomy?

The price you'll pay for a lumpectomy varies based on factors like:

  • Your health insurance plan. Your coinsurance, copay and how much of your deductible you've met affects the amount you pay for a lumpectomy out of pocket, does as whether your doctor or anyone else involved is outside your network.
  • Your location. Where you live dictates which doctors or healthcare facilities you have access to for a lumpectomy. Urban areas are more competitive, which can drive down costs for a lumpectomy compared to rural areas.
  • Your doctor. Your doctor's experience and expertise affects how much they charge for a lumpectomy. And the cost may increase if complications arise during a lumpectomy and your doctor has to call in other medical professionals.
  • Additional fees. Your healthcare provider may charge associated fees that increase the overall cost of a lumpectomy.

How to cut your costs for a lumpectomy

In the leadup to a lumpectomy, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.

  • Dip into your HSA, FSA or HRA. These tax-advantaged accounts can help you to cover out-of-pocket costs for a lumpectomy.
  • Ask about financial aid. If you can't afford to pay the average cost of $9,234 with or without insurance, most hospitals and clinics offer financial aid programs that include discounts or interest-free payment plans.
  • Explore outpatient centers. Outpatient facilities tend to charge less for medical procedures like a lumpectomy, though they're not an option for everyone.
  • Consider medical loans. A medical loan could help pay for anything your health insurance doesn't cover for a lumpectomy, like copays or coinsurance.
  • Compare doctors and hospitals. Lower the price of medical services by comparing in-network hospitals before you schedule a lumpectomy. The Centers for Medicare and Medicaid Services require hospitals and clinics to publish online price lists for common procedures, which may include costs for a lumpectomy.

Bottom line

The price of a lumpectomy is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for a lumpectomy can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.

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