Average Charge and Payment Data for 7 Lower-GI Procedures Commonly Performed in ASCs

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.

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By: Staff

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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