Five notes:
1. GI facilities will see an average reimbursement reduction of between 3% and 5%, according to Healthcare Appraisers’ 2023 GI “Industry Outlook” report. ASCs will see a 7% to 9% increase in reimbursements, and hospital outpatient departments will see a 5% to 6% increase.
2. The cost of a diagnostic colonoscopy at ASCs increased by 10% between 2017 and 2022, compared to 17% at HOPDs, according to the Blue Health analysis. Colonoscopy screenings cost 32 percent more in HOPDs than at ASCs and double than when performed in a physician’s office. Diagnostic colonoscopies cost 58 percent more in an HOPD than in an ASC.
3. U.S. hospitals’ facility fees for colonoscopy procedures covered by private health insurance are 55% higher than those at ASCs as of May 2023, according to a Johns Hopkins Bloomberg School of Public Health study published in JAMA Health Forum.
4. Colonoscopy complication rates were slightly lower — 0.2% — in HOPDs than in ASC settings after adjustment for other relevant factors, according to a study published in April in The American Journal of Managed Care, but “the difference is not statistically significant.” At HOPDs, there was a 55.4% higher price for colonoscopy.
5. How reimbursement fees will increase or decrease by setting for the five most popular GI CPT codes, which are all related to esophagogastroduodenoscopy or colonoscopy, according to the Healthcare Appraisers report.
43235
Non-facility: -4%
Facility: -3%
ASC: 7%
HOPD: 6%
43239
Non-facility: -4%
Facility: -2%
ASC: 7%
HOPD: 6%
43246
Non-facility: N/A
Facility: -3%
ASC: 9%
HOPD: 5%
43248
Non-facility: -4%
Facility: -3%
ASC: 7%
HOPD: 6%
43249
Non-facility: -5%
Facility: -3%
ASC: 9%
HOPD: 5%
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