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Average Charge and Payment Data for 7 Lower-GI Procedures Commonly Performed in ASCs Print E-mail
Written by Stephanie Wasek   
Friday, 22 August 2008
Here is the average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for seven lower-GI procedures commonly performed in ASCs.

1. Scope of colon thru ostomy for diagnosis (CPT 44388)
- average sub charge: $1,203
- average allow charge $323
- average payment: $253

2. Scope of colon with biopsy thru ostomy (CPT 44389)
- average sub charge: $1,338
- average allow charge $308
- average payment: $240

3. Scope of sigmoid colon only with biopsy (CPT 45331)
- average sub charge: $945
- average allow charge $287
- average payment: $225

4. Scope of colon for diagnosis (CPT 45378)
- average sub charge: $1,403
- average allow charge $442
- average payment: $345

5. Scope of colon with biopsy (CPT 45380)
- average sub charge: $1,463
- average allow charge $407
- average payment: $319

6. Cancer screen colon scope, high risk patient (HCPCS G0105)
- average sub charge: $1,272
- average allow charge $441
- average payment: $339

7. Cancer screen colon scope, not high risk patient (HCPCS G0121)
- average sub charge: $1,327
- average allow charge $443
- average payment: $340

 
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