How Much Does Scoliosis Surgery Cost?
By David K. Wolpert
Until recently, there has been no reliable data published on what scoliosis surgery costs in the United States. Various websites throw out broad ranges, from $10,000 to $300,000, though it’s unclear what the source of those figures is. For what it’s worth, mine cost about $150,000.
But a reliable source is now available.
The Centers for Medicare & Medicaid Services (CMMS) has released data on charges paid in 2011 at 3,000 hospitals across the country for specific treatments. One of those treatments—technically called a Diagnosis Research Group, or DRG—is DRG 460, “Spinal Fusion Except Cervical w/o MCC” (Major Complications or Comorbidity).
DRG 460 could cover scoliosis surgery but that would normally be covered under DRGs 456, 457 or 458. (Data for those DRGs is not available.) Still, most longer spinal fusions involve many of the same procedures and instrumentation, and thus these costs should be comparable.
You can download the Microsoft Excel file of this data from CMS.gov and then filter it by DRG and zip code to find out what hospitals in your area charge for this surgery. This is important, since most insurance plans will only cover 80% or 90% of these charges. Some portion of the rest could be out of your pocket.
Here are some quick instructions to do this. If you’re not technically savvy, you may need to do some searching on Google for help on these steps.
- Download the Excel file. This is a very large file and will take some time to download. Also note that this is a .zip file (a compressed format) and you will need to unzip it first to open. You will of course also need Microsoft Excel for PC or Mac.
- Once you unzip it, open the Excel file.
- Filter Column A (DRG Definition) for “460 - SPINAL FUSION EXCEPT CERVICAL W/O MCC.”
- Then filter Column E (Provider City) for whatever city you live in or are considering having your surgery performed in.
- Column I (Total Discharge) will tell you how many surgeries were performed at each hospital, and Column J (Average Covered Charges) gives you a feel for what the hospital, on average, charged Medicare for those surgeries.
Now, a few very important points. First, as mentioned earlier, this covers spinal fusions for reasons other than scoliosis. The cost of a spinal fusion varies mainly based on how many levels (vertebrae) were fused. So, a fusion of two vertebrae that were fractured in a car accident will be far less expensive than a fusion to correct a scoliotic curve, which might involve seven or eight (or more) vertebrae. So, take these values with a grain of salt.
Second, make sure to compare the right kinds of hospitals. Scoliosis surgeries tend to be performed only at the largest hospitals in a region, whereas smaller hospitals might perform shorter fusions. Looking at only the larger hospitals improves the odds that you’re looking at a data set that includes spinal fusions for scoliosis.
Third, note that this is Medicare-related data. Claims filed with private insurance companies—which are the bulk of them—are not included here. However, the key point is that the charges would be roughly the same.
Finally, charges for scoliosis surgery vary based on all kinds of things beyond the number of vertebrae fused. A partial list includes:
- How long you stay in the hospital.
- The type and material (stainless steel or titanium) of instrumentation used.
- Fees for support staff your surgeon chooses, such as the anesthesiologist.
- Whether you have thoracoplasty as part of your procedure.
- The type of bone grafting material used.
Consider the data directional, not exact—that is, hospitals that charge more on average will tend to be more expensive, but you can’t reliably say that Hospital X always charges $20,000 more than hospital Y.
So what do we find? Well, I looked at Austin, Texas data. There’s data for six hospitals, but two are small. Excluding those, the other hospitals charged an average of between $130,617 and $165,840. That’s a big spread, though it gives you a rough feel.
But here’s the shocker. In Dallas, the highest average charge for spinal fusion was $116,106. And in Houston, the highest was $131,317. Does that mean that Austin is a pricey place to have scoliosis surgery in Texas? Probably. Of course, it might be worth it if you find a great surgeon here. This data is just one of many things to consider.
Parts of the rest of the country make Texas look cheap. Take a look at this list of the 10 most expensive hospitals for spinal fusions.
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