Research Article|Articles in Press

Surgical Markup in Lung Cancer Resection (2015 -2020)

Open AccessPublished:May 08, 2023DOI:
      This paper is only available as a PDF. To read, Please Download here.



      The objective of this study was to assess procedure markup (charge-to-cost ratio) across lung resection procedures and examine variability by geographic region.


      Provider-level data for common lung resection operations was obtained from the 2015 to 2020 Medicare Provider Utilization and Payment Data datasets using HCPCS codes. Procedures studied included wedge resection, VATS and Open lobectomy, segmentectomy and mediastinal & regional lymphadenectomy. Procedure markup ratio and coefficient of variation was assessed and compared across procedure, region, and provider. The coefficient of variation, a measure of dispersion defined as the ratio of the standard deviation to the mean, was likewise compared across procedure and region.


      Median markup ratio across all procedures was 3.56 (IQR: 2.87 - 4.59) with right skew (mean = 4.13). Median markup ratio was 3.59 for lymphadenectomy (CoV: 0.51), 3.13 for open lobectomy (CoV:0.45), 3.55 for VATS lobectomy (CoV:0.59), 3.77 for segmentectomy (CoV: 0.74), and 3.80 for wedge resection (CoV: 0.67) Increased beneficiaries, services, and HCPCS (total) were associated with a decreased markup ratio (p <.0001). Markup ratio was highest in the Northeast at 4.14 (IQR: 3.09-5.56) and lowest in the South (MR 3.26: IQR 2.68-4.02).


      We observe geographic variation in surgical billing for thoracic surgery.

      Graphical abstract



      BPCI (Bundled Payments for Care Improvement), CMS (Center for Medicare & Medicaid Services), COPD (Chronic Obstructive Pulmonary Disease), CoV (Coefficient of Variation), FOIA (Freedom of Information Act), HCC risk score (Hierarchical Condition Categories), HCPC (Healthcare Common Procedure Coding System), IQR (Interquartile Range), LDCT (Low-dose CT-screening), NLST (National Lung Screening Trial), NPI (National Provider Identifier), USPSTF (US Preventive Services Task Force), VATS (Video-Assisted Thoracoscopic Surgery)