Shoppable Services (Payer)

Thanks to Transparency in Coverage (TiC), payers must publish an online Patient Estimate Tool (PET) that calculates out-of-pocket cost information (in addition to conveying underlying negotiated rates) for a list of 500 pre-determined shoppable services. This requirement mirrors requirement for hospitals, who are required to post a total of 300 shoppable services.

What are shoppable services?

Shoppable Services are any service that can be planned in advance, thus allowing patients to shop around before scheduling an appointment. For the second requirement of TiC, payers were required to make the cost of 500 pre-determined shoppable services available in a patient estimate tool as of 1/1/2023.

The intention is to provide a preliminary cost estimate prior to receiving services; you would usually only receive this information after receiving care in the form of an EOB (Explanation of benefits). The Patient Estimate Tool must be made available to plan participants, beneficiaries, and enrollees, who may also request the estimates and rates in paper form.

List of 500 Required Shoppable Services

To review the full list of 500 required shoppable services, head to page 93 in this document.