CMS cuts to colonoscopy reimbursement finalized: 3 things to know

CMS has released its CY 2016 Physician Fee Schedule Final Rule, and the final rule includes reimbursement cuts for colonoscopy. 

Here are three things to know about the reimbursement cuts, according to the American Gastroenterological Association.

1. The reimbursement cuts were initially proposed in July. The AGA banded together with its sister GI societies — the American College of Gastroenterology and American Society of Gastrointestinal Endoscopy — to work with CMS to mitigate the cuts.

2. The reimbursement cuts for some procedures are more than 17 percent.

3. Here are the top 10 lower GI codes subject to cuts for CY 2016 by final RVU percentage change:

  • Colonscopy with snare polypectomy (CPT code 45385): -12 percent
  • Colonoscopy (CPT code 45373): -9 percent
  • Colorectal cancer screen, high risk (CPT code G0105): 0 percent
  • Colorectal cancer screen, low risk (CPT code G0121): 0 percent
  • Colonoscopy with hot biopsy (CPT code 45384): -11 percent
  • Colonoscopy with submucosal injection (CPT code 45381): -13 percent
  • Flexible colonoscopy with ablation (CPT code 45388): -15 percent
  • Flexible sigmoidoscopy with biopsy (CPT code 45331): -1 percent
  • Flexible sigmoidoscopy (CPT code 45330): -13 percent
  • Colonoscopy with control of bleeding (CPT code 45382): -16 percent

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