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.

Advertisement

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

At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.

Advertisement

Next Up in ASC Coding, Billing & Collections

  • Atlanta-based United Digestive is planning an ASC in Watkinsville, Ga., focusing on organic growth to expand its network. The newly-constructed,…

  • At least 25 ASCs have closed over the past five years, a pattern of attrition driven by financial strain, staffing…

  • As the ASC industry continues to grow alongside new waves of surgical innovation, patient preferences and shifts to value-based care,…

Advertisement

Comments are closed.