How to read a hospital bill

Summary bill vs. itemized bill

There are two versions of almost every hospital bill. The summaryis what you usually get first — it groups charges into department totals like “Pharmacy” or “Operating Room” and shows little else. The itemized version lists every charge on its own line, with a code, a quantity, and a price.

You can read a summary, but you cannot check it — there is nothing to compare a department total against. If all you have is a summary, our free request letter asks the hospital for the itemized version under your HIPAA right of access.

The codes, decoded

Most lines on an itemized bill carry one or more codes. Here is what each kind tells you:

• CPT code (5 digits). Identifies a procedure or service. This is the code you compare against a price benchmark. Higher numbers within a family often signal a more complex, costlier level — an emergency-visit code like 99285 marks the highest level, for instance.
• HCPCS code. Covers drugs, supplies, and some services. Drug lines (codes starting with J, for example) can be compared against the federal acquisition cost.
• Revenue code (3–4 digits). Groups a charge by hospital department — lab, pharmacy, radiology. On a summary bill, this is often all you get.
• Diagnosis code (ICD-10). Describes the condition, not the price. It explains why a service was done, which matters for insurance coverage.

When a term is unfamiliar, our glossary defines it in plain English.

The columns: charged, allowed, paid, owed

Past the codes, a bill (and the EOB that goes with it) usually shows a few money columns:

• Charged. The hospital’s list price for the line — the “chargemaster” rate. It is often far higher than what anyone actually pays.
• Allowed. The rate your insurer agreed to. The difference between charged and allowed is the plan’s negotiated discount.
• Paid. What the plan actually paid.
• Your responsibility. What is left for you — deductible, copay, coinsurance.

Your Explanation of Benefits (EOB) comes from the insurer and shows these same columns. The hospital bill and the EOB should roughly reconcile. If the hospital is asking you to pay much more than the EOB says you owe, start there.

What to check once you can read it

Reading the bill is half the job. Checking it is the other half. The quickest tells:

• the same line billed twice,
• a service coded at a higher level than the care you remember,
• one package of care split into many separately-priced lines,
• a drug, supply, or room charge sitting far above the public benchmark.

When you find one, the next move is a specific letter. Our step-by-step dispute guide walks through it, or the audit compares every line against six federal data sources and drafts the letters for you.

Common questions