Friday, July 30, 2010

GI Endoscopy Procedure Reimbursement - CPT 43200,43201,43204,43215,

2010 Medicare GI Endoscopy Procedure Reimbursement Guide


 ESOPHAGOSCOPY   Ambulatory
Surgery Center
Outpatient
Hospital
Physician
Services
Code Procedure Description ASC Facility Fee
(National Medicare Avg)
APC Facility Fee
Schedule
(National Medicare Avg)²
Fee When
Procedure
Performed in
Hospital or ASC
(National Medicare Avg)³
Fee When
Procedure
Performed
in Office
(National Medicare Avg)³
43200  Esophagoscopy, rigid or flexible; diagnostic,  with or without collection of specimen(s) by   brushing or washing (separate procedure)    $342.42    0141    $589.55    $101.76    $201.71  
43201  ...with directed submucosal injection(s), any substance    $342.42    0141    $589.55    $127.38    $276.41  
43202  ...with biopsy, single or multiple    $342.42    0141    $589.55    $113.31    $264.50  
43204  …with injection sclerosis of esophageal varices    $342.42    0141    $589.55    $221.20    NA*  
43205  ...with band ligation of esophageal varices    $342.42    0141    $589.55    $221.56    NA*  
43215  ...with removal of foreign body    $342.42    0141    $589.55    $152.64    NA*  
43216  ... with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery    $342.42    0141    $589.55    $141.45    $192.69  
43217  ...with removal of tumor(s), polyp(s), or other lesion(s) by snare technique    $342.42    0141    $589.55    $168.52    $354.71  
43219  ...with insertion of plastic tube or stent    $875.58    0384    $1,785.67    $169.60    NA*  
43220  ...with balloon dilation (less than 30 mm diameter)    $342.42    0141    $589.55    $125.57    NA*  
43226  ...with insertion of guide wire followed by dilation over guide wire    $342.42    0141    $589.55    $139.29    NA*  
43227  ...with control of bleeding (e.g., injection,   bipolar cautery, unipolar cautery, laser, heater   probe, stapler, plasma coagulator)    $369.45    0141    $589.55    $208.21    NA*  
43228  ...with ablation of tumor(s), polyp(s), or other  lesion(s), not amenable to removal by hot biopsy   forceps, bipolar cautery or snare technique    $835.87    0422    $1,635.96    $220.48    NA*  
43231  ...with endoscopic ultrasound examination    $369.45    0141    $589.55    $188.72    NA*  
43232  ...with transendoscopic ultrasound-guided   intramural or transmural fine needle   aspiration/biopsy(s)    $369.45    0141    $589.55    $260.17    NA*  

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