Monday, July 19, 2010

Medicare reimbursement for FLEXIBLE COLONOSCOPY CPT 45378,45379

2010 Medicare GI Endoscopy Procedure Reimbursement Guide for FLEXIBLE COLONOSCOPY


FLEXIBLE COLONOSCOPY 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
45378  Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing,  with or without colon decompression   (separate procedure)    $380.23    0143    $613.74    $213.98    $374.20  
45379  …with removal of foreign body    $380.23    0143    $613.74    $268.11    $475.60  
45380  …with biopsy, single or multiple    $380.23    0143    $613.74    $256.92    $447.81  
45381  …with directed submucosal injection(s), any substance    $380.23    0143    $613.74    $243.57    $435.54  
45382  …with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)    $380.23    0143    $613.74    $328.37    $588.18  
45383  …with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy  forceps, bipolar cautery or snare technique    $380.23    0143    $613.74    $331.62    $537.30  
45384  …with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery      $380.23    0143    $613.74    $268.47    $443.48  
45385  …with removal of tumor(s), polyp(s), or other lesion(s) by snare technique    $380.23    0143    $613.74    $305.28    $505.55  
45386  …with dilation by balloon, 1 or more strictures    $380.23    0143    $613.74    $262.70    $620.29  
45387  …with transendoscopic stent placement (includes predilation)    $875.58    0384    $1,785.67    $342.08    NA*  
45391  …with endoscopic ultrasound examination    $380.23    0143    $613.74    $294.09    NA*  
45392  …with transendoscopic ultrasound guided intramural or transmural fine needle  aspiration/biopsy(s)     $380.23    0143    $613.74    $376.00    NA*  

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