CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
1. Upper stomach-intestine scope, simple (CPT 43234)
- average sub charge: $1,025
- average allow charge: $329
- average payment: $259
2. Upper stomach-intestine scope for diagnosis (CPT 43235)
- average sub charge: $1,117
- average allow charge $325
- average payment: $255
3. Stomach-intestine scope, inject intestine wall (CPT 43236)
- average sub charge: $1,359
- average allow charge $338
- average payment: $267
4. Upper stomach-intestine scope for biopsy (CPT 43239)
- average sub charge: $1,451
- average allow charge $408
- average payment: $321
5. Stomach-intestine scope ultrasound guided biopsy (CPT 43242)
- average sub charge: $2,116
- average allow charge $404
- average payment: $320
6. Stomach-intestine scope for foreign body removal (CPT 43247)
- average sub charge: $1,458
- average allow charge $408
- average payment: $322
7. Stomach-intestine scope with ultrasound exam (CPT 43259)
- average sub charge: $2,232
- average allow charge $452
- average payment: $359
8. Scope of upper small intestine (CPT 44360)
- average sub charge: $1,419
- average allow charge $416
- average payment: $328
9. Scope of upper small intestine with biopsy (CPT 44361)
- average sub charge: $1,344
- average allow charge $425
- average payment: $336
10. Scope of colon thru ostomy for diagnosis (CPT 44388)
- average sub charge: $1,325
- average allow charge $334
- average payment: $262
11. Scope of colon with biopsy thru ostomy (CPT 44389)
- average sub charge: $1,354
- average allow charge $325
- average payment: $255
12. Scope of sigmoid colon only with biopsy (CPT 45331)
- average sub charge: $967
- average allow charge $267
- average payment: $208
13. Scope of colon for diagnosis (CPT 45378)
- average sub charge: $1,502
- average allow charge $422
- average payment: $330
14. Scope of colon with biopsy (CPT 45380)
- average sub charge: $1,549
- average allow charge $406
- average payment: $318
15. Cancer screen colon scope, high risk patient (HCPCS G0105)
- average sub charge: $1,308
- average allow charge $409
- average payment: $306
16. Cancer screen colon scope, not high risk patient (HCPCS G0121)
- average sub charge: $1,415
- average allow charge $412
- average payment: $308
Source: CMS
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.