ASC vs. HOPD reimbursement for 10 common ASC procedures

Reimbursement differences between hospital outpatient departments and ASCs are a longstanding point of contention among ASC professionals, with Medicare ASC payments increasing only marginally while Medicare hospital pay has seen comparatively significant jumps.

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Below are the average Medicare reimbursements for the 10 most common procedures performed at ASCs, using facility and physician fee data from Medicare’s Procedure Price Lookup tool. 

Procedure with HCPCS/CPT code

 ASC facility and physician fee 

 HOPD facility and physician fee 

1. Excision of cataract with removal of lens, without ECP (66984)

$1,368

$2,198

2. Colonoscopy, with removal of lesion(s) (45385)

$685

$1,095

3. Colonoscopy, with biopsy, single/multiple (45380)

$644

$1,054

4. Esophagogastroduodenoscopy, biopsy, single/multiple (43239)

$483

$797

5. Diagnostic colonoscopy (45378)

$521

$838

 6. Injection(s), anesthetic agent and/or steroid, lumbar/sacral (64483) 

$464

$780

7. Anesthesia for lower intestine scope, colonoscopy (812)

Fees not available.

Fees not available.

8. Injection(s), anesthetic agent and/or steroid, lumbar/sacral (64493)

$448

$764

9. Destruction of lumbar/sacral facet joint(s) by neurolytic (64635)

$868

$1,621

10. Incision of eardrum to create opening (69436)

$659

$1,288

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