22 GI Statistics for Surgery Centers

Here are 22 statistics about GI/endoscopy in surgery centers.

1. GI/endoscopy represents 25 percent of the average case volume in surgery centers, the most of all specialties. The average surgery center performs 4,869 cases annually, which would average to about 1,217 GI cases annually.

2. The average gross charges for GI cases are $3,040. The average case revenue is $790.

3. Surgery centers in the Southwest received the highest average net revenue per GI case with $950. Average net revenue was lowest in the Southeast at $653 per case.

4. Here are the average net revenues per GI case by the number of operating rooms in a surgery center:

• 1-2 ORs — $676
• 3-4 ORs — $771
• More than 4 ORs — $947

5. Here are the average net revenues per GI case by a surgery center's total annual case volume:

• Less than 3,000 cases — $748
• 3,000-5,999 cases — $843
• More than 5,999 cases — $772

6. Here are the average net revenues per GI case by a surgery center's total net revenue:

• Less than $4.5 million — $692
• $4.5-$7.0 million — $763
• More than $7.0 million — $959

Medicare charges and payments
Here is the average 2008 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 16 GI procedures commonly performed in ASCs.

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7. Upper stomach-intestine scope, simple (CPT 43234)

• average sub charge: $1,025
• average allow charge: $329
• average payment: $259

8. Upper stomach-intestine scope for diagnosis (CPT 43235)

• average sub charge: $1,117
• average allow charge: $325
• average payment: $255

9. Stomach-intestine scope, inject intestine wall (CPT 43236)

• average sub charge: $1,359
• average allow charge: $338
• average payment: $267

10. Upper stomach-intestine scope for biopsy (CPT 43239)

• average sub charge: $1,451
• average allow charge: $408
• average payment: $321

11. Stomach-intestine scope ultrasound guided biopsy (CPT 43242)

• average sub charge: $2,116
• average allow charge: $404
• average payment: $320

12. Stomach-intestine scope for foreign body removal (CPT 43247)

• average sub charge: $1,458
• average allow charge: $408
• average payment: $322

13. Stomach-intestine scope with ultrasound exam (CPT 43259)

• average sub charge: $2,232
• average allow charge: $452
• average payment: $359

14. Scope of upper small intestine (CPT 44360)

• average sub charge: $1,419
• average allow charge: $416
• average payment: $328

15. Scope of upper small intestine with biopsy (CPT 44361)

• average sub charge: $1,344
• average allow charge: $425
• average payment: $336

16. Scope of colon thru ostomy for diagnosis (CPT 44388)

• average sub charge: $1,325
• average allow charge: $334
• average payment: $262

17. Scope of colon with biopsy thru ostomy (CPT 44389)

• average sub charge: $1,354
• average allow charge: $325
• average payment: $255

18. Scope of sigmoid colon only with biopsy (CPT 45331)

• average sub charge: $967
• average allow charge: $267
• average payment: $208

19. Scope of colon for diagnosis (CPT 45378)

• average sub charge: $1,502
• average allow charge: $422
• average payment: $330

20. Scope of colon with biopsy (CPT 45380)

• average sub charge: $1,549
• average allow charge: $406
• average payment: $318

21. Cancer screen colon scope, high risk patient (HCPCS G0105)

• average sub charge: $1,308
• average allow charge: $409
• average payment: $306

22. Cancer screen colon scope, not high risk patient (HCPCS G0121)

• average sub charge: $1,415
• average allow charge: $412
• average payment: $308

Sources:
Items 1-6: VMG Health's 2009 Intellimarker.
Items 7-22: CMS