The chargemaster is a hospital’s master list of prices for every item and service it provides. Those prices are set internally and bear little relationship to cost or to what anyone actually pays.
Who pays what, in practice:
- Insurers pay a negotiated rate, usually a fraction of chargemaster.
- Medicare and Medicaid pay set rates, lower still.
- Uninsured patients get billed at chargemaster — the highest number in the building.
That last line is the whole reason this term matters. The bill an uninsured New Yorker receives is the list price, and New York law then says that patient often shouldn’t pay most of it: below 200% of the federal poverty level, no out-of-pocket charges at all; between 201% and 300%, no more than 10% of the Medicaid rate.
Federal price transparency rules require hospitals to publish machine-readable files of their standard charges and negotiated rates. The files are unwieldy, but they’re public, and for a planned procedure they’re the only place the real numbers live.
If you’re holding a bill built on chargemaster rates, the first move isn’t payment — it’s an itemized bill and a financial assistance application.
Also called: charge description master, CDM, list price. Reference: Chargemaster on Wikipedia — general definition, not New York specifics.
More in Glossary of health coverage and billing terms
- Good faith estimate — A written cost estimate uninsured and self-pay patients are entitled to before scheduled care.
- Balance billing — When a provider bills you for the gap between its charge and what your plan paid.
- Federal poverty level (FPL) — A federal income benchmark, updated each January, that decides eligibility for most health programs in New York.
This page explains how the system works. It is not medical advice. More.