colonoscopies

[wasatch]

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I am looking to do private practice. Can anyone give me an idea what reimbursements are for doing screeing colonoscopies with and without biopsy. I want to see if it true that the fees have gone down so much that it is becoming cost prohibative to do this service. Thanks.

 

[andwhat]

I am looking to do private practice. Can anyone give me an idea what reimbursements are for doing screeing colonoscopies with and without biopsy. I want to see if it true that the fees have gone down so much that it is becoming cost prohibative to do this service. Thanks.

I am interested in reimbursement numbers in the following procedures:

1) Colposcopy

2) Pap smear

3) Vasectomy

4) Skin biopsy (thats a tough one probably to figure out, subjectivity does exist)

5) Endometrial Biopsy

6) Botox??? another vague one.


How is the reimbursement typically on these in office procedures, for one, Vasectomy costs the patient approximately between $800 and up to $1200 or so dollars. Each one takes like an hour, wonder what is the reimbursement. Anybody know? I should be reading Swanson's for the intraining examination instead of wondering about this yeah I know 🙄

 

[deleted87716]

There really is no answer to this question, as reimbursement for each of these services will vary between payors, localities, etc.

In the spirit of "teach a man to fish," you can look up the Medicare reimbursements here: http://www.cms.hhs.gov/apps/pfslookup/step0.asp

You'll need to know the CPT codes for the procedures you're interested in.

Consider those fees a worst-case scenario.

 

[wasatch]

I was quoted $170 per colonoscopy. That seems quite low to me. Is this about what you thought kentw? If that is right, I can make more per hour seeing pts than doing a colonoscopy...with driving to the hospital and so on.

 

[deleted87716]

I was quoted $170 per colonoscopy. That seems quite low to me. Is this about what you thought kentw? If that is right, I can make more per hour seeing pts than doing a colonoscopy...with driving to the hospital and so on.

I did look up the Medicare fees for colonoscopy. They averaged around $300 for the professional fee, and around $150 for the facility fee. The big GI group here has their own endoscopy suite, so they get both fees*, and can work fast (3-4 'scopes an hour).

*Edit: Not exactly. See below.

 

[Faebinder]

Forget colonoscopy.... It will not be in fashion for long.

http://www.cnn.com/2006/HEALTH/10/18/colonoscopy.reut/index.html

Unless you want to be the one removing the polyp when the X-ray colonoscopy finds it.

 

[Newdoc2002]

The CT scan as screening keeps coming up and may replace some screenings at some point but this has been a threat for years that hasn't panned out.

 

[deleted87716]

The CT scan as screening keeps coming up and may replace some screenings at some point but this has been a threat for years that hasn't panned out.

The diagnostic accuracy of "virtual colonoscopy," as it's known, is highly operator-dependent. No insurers that I know of are currently reimbursing for it. More info: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Virtual_Colonoscopy_Not_Ready_for_Routine_Use.asp

 

[Faebinder]

Radiology is very good at taking other specialty turffs... I am sure they will work on it.

 

[core0]

I did look up the Medicare fees for colonoscopy. They averaged around $300 for the professional fee, and around $150 for the facility fee. The big GI group here has their own endoscopy suite, so they get both fees, and can work fast (3-4 'scopes an hour).

You have it backward. The professional fee is about $170 the and the facility fee is about $600 (this is regional). This is still better than you can do for an office visit (assumes 2 per hour). Insurance pays much better. The real problem is that GI is working to make sure that you have 500+ to get credentialled. There are plenty of FP's doing this in the hinterland. Expect GI to fight you in the city. Also, from what I've seen the FP docs are having complication rates at about the rate you would expect from their experience (similar to a fellow). They seem to be late in recognizing complications. Lots of lawsuit potential here.

David Carpenter, PA-C

 

[deleted87716]

You have it backward. The professional fee is about $170 the and the facility fee is about $600 (this is regional).

No, actually, you have it backwards.

This isn't going to look pretty, since I can't paste in a table, but this is directly from the Medicare site (see below). Note that the non-facility price is listed first, the facility price second. The rough averages I quoted were simply from scanning the table. If you want to total them up and divide by 91, please feel free. 😉

Note also that CPT 44388 is for colonoscopy by itself. If you search on additional CPT codes, such as 44392 (colonoscopy with polypectomy), you'll find that the prices are slightly higher for more complex codes.

As for private insurance paying more, that's certainly the case with a lot of payors, but perhaps not with others. At any rate, these figures are not readily available, unlike Medicare fees.

Clinicians would be well-advised to conduct a thorough cost-benefit analysis, including malpractice expenses, before taking on any additional procedures. Fees are only one variable in the equation.

Get Pricing by Single HCPC for Nation

Searching Criteria
Year 2006
HCPC 44388
Modifier All modifiers
Carr/Loc Nation
Fields Option Default Fields


91 records found.


HCPC Modifier Short Description Proc Stat Carrier/ Locality Non-Facility Price Facility Price Conv Fact NA Flag for Non-Fac PE RVU NA Flag for Facility PE RVU Not Used For Medicare
44388 Colonoscopy A 0051000 $277.47 $151.15 37.8975
44388 Colonoscopy A 0051199 $284.60 $154.39 37.8975
44388 Colonoscopy A 0052013 $271.49 $147.40 37.8975
44388 Colonoscopy A 0052200 $275.37 $147.85 37.8975
44388 Colonoscopy A 0052399 $270.36 $150.61 37.8975
44388 Colonoscopy A 0052801 $301.15 $159.89 37.8975
44388 Colonoscopy A 0059003 $314.23 $166.71 37.8975
44388 Colonoscopy A 0059099 $299.57 $160.11 37.8975
44388 Colonoscopy A 0063000 $285.93 $150.65 37.8975
44388 Colonoscopy A 0065500 $280.13 $149.48 37.8975
44388 Colonoscopy A 0066000 $280.21 $152.69 37.8975
44388 Colonoscopy A 0074002 $304.27 $158.68 37.8975
44388 Colonoscopy A 0074099 $270.36 $150.61 37.8975
44388 Colonoscopy A 0075101 $278.58 $152.56 37.8975
44388 Colonoscopy A 0080199 $290.43 $153.51 37.8975
44388 Colonoscopy A 0080301 $379.02 $185.21 37.8975
44388 Colonoscopy A 0080302 $376.93 $185.80 37.8975
44388 Colonoscopy A 0080303 $327.04 $166.67 37.8975
44388 Colonoscopy A 0080501 $357.99 $175.83 37.8975
44388 Colonoscopy A 0080599 $336.91 $169.82 37.8975
44388 Colonoscopy A 0082001 $278.70 $150.28 37.8975
44388 Colonoscopy A 0082002 $279.45 $148.65 37.8975
44388 Colonoscopy A 0082309 $294.14 $154.23 37.8975
44388 Colonoscopy A 0082401 $310.38 $158.98 37.8975
44388 Colonoscopy A 0082521 $280.63 $153.26 37.8975
44388 Colonoscopy A 0082600 $280.11 $150.50 37.8975
44388 Colonoscopy A 0083101 $331.59 $166.90 37.8975
44388 Colonoscopy A 0083200 $308.76 $160.64 37.8975
44388 Colonoscopy A 0083301 $329.60 $163.71 37.8975
44388 Colonoscopy A 0083400 $318.91 $163.17 37.8975
44388 Colonoscopy A 0083501 $315.32 $157.50 37.8975
44388 Colonoscopy A 0083599 $289.65 $151.53 37.8975
44388 Colonoscopy A 0083602 $334.60 $165.73 37.8975
44388 Colonoscopy A 0083699 $303.60 $157.56 37.8975
44388 Colonoscopy A 0086501 $335.20 $170.35 37.8975
44388 Colonoscopy A 0086599 $288.81 $154.12 37.8975
44388 Colonoscopy A 0088001 $283.01 $149.67 37.8975
44388 Colonoscopy A 0088300 $296.46 $157.15 37.8975
44388 Colonoscopy A 0088416 $280.10 $157.81 37.8975
44388 Colonoscopy A 0090009 $307.17 $163.68 37.8975
44388 Colonoscopy A 0090011 $323.15 $164.57 37.8975
44388 Colonoscopy A 0090015 $303.30 $161.15 37.8975
44388 Colonoscopy A 0090018 $316.96 $165.55 37.8975
44388 Colonoscopy A 0090020 $285.55 $157.14 37.8975
44388 Colonoscopy A 0090028 $308.10 $160.43 37.8975
44388 Colonoscopy A 0090031 $318.36 $162.17 37.8975
44388 Colonoscopy A 0090099 $284.94 $155.78 37.8975
44388 Colonoscopy A 0090101 $325.43 $164.47 37.8975
44388 Colonoscopy A 0090199 $303.40 $157.07 37.8975
44388 Colonoscopy A 0090201 $313.31 $161.31 37.8975
44388 Colonoscopy A 0090301 $362.25 $175.60 37.8975
44388 Colonoscopy A 0090400 $293.90 $153.54 37.8975
44388 Colonoscopy A 0095100 $291.74 $154.66 37.8975
44388 Colonoscopy A 0095212 $305.25 $165.04 37.8975
44388 Colonoscopy A 0095215 $340.15 $173.67 37.8975
44388 Colonoscopy A 0095216 $345.14 $177.01 37.8975
44388 Colonoscopy A 0095299 $286.83 $156.63 37.8975
44388 Colonoscopy A 0095301 $341.18 $183.80 37.8975
44388 Colonoscopy A 0095399 $299.49 $161.97 37.8975
44388 Colonoscopy A 0095400 $304.77 $154.71 37.8975
44388 Colonoscopy A 0097320 $244.09 $139.86 37.8975
44388 Colonoscopy A 0097350 $312.35 $160.95 37.8975
44388 Colonoscopy A 0513000 $278.83 $149.22 37.8975
44388 Colonoscopy A 0544035 $282.65 $151.40 37.8975
44388 Colonoscopy A 0553500 $290.64 $153.27 37.8975
44388 Colonoscopy A 1433004 $364.02 $180.66 37.8975
44388 Colonoscopy A 3114003 $375.51 $175.43 37.8975
44388 Colonoscopy A 3114005 $417.34 $186.94 37.8975
44388 Colonoscopy A 3114006 $417.26 $187.91 37.8975
44388 Colonoscopy A 3114007 $383.52 $178.81 37.8975
44388 Colonoscopy A 3114009 $418.76 $188.81 37.8975
44388 Colonoscopy A 3114099 $317.96 $160.73 37.8975
44388 Colonoscopy A 3114203 $308.55 $157.30 37.8975
44388 Colonoscopy A 3114299 $284.06 $151.76 37.8975
44388 Colonoscopy A 3114301 $374.55 $176.11 37.8975
44388 Colonoscopy A 3114399 $328.50 $163.80 37.8975
44388 Colonoscopy A 3114440 $314.26 $160.91 37.8975
44388 Colonoscopy A 3114550 $298.66 $154.12 37.8975
44388 Colonoscopy A 3114617 $344.62 $168.58 37.8975
44388 Colonoscopy A 3114618 $343.64 $171.03 37.8975
44388 Colonoscopy A 3114626 $358.33 $173.77 37.8975
44388 Colonoscopy A 3114699 $317.96 $160.73 37.8975
44388 Colonoscopy A 0051101 $327.52 $164.92 37.8975
44388 Colonoscopy A 0051200 $275.83 $150.55 37.8975
44388 Colonoscopy A 0052105 $286.79 $154.35 37.8975
44388 Colonoscopy A 0052301 $300.36 $157.76 37.8975
44388 Colonoscopy A 0052401 $311.41 $163.74 37.8975
44388 Colonoscopy A 0052899 $280.68 $154.21 37.8975
44388 Colonoscopy A 0059004 $331.00 $174.82 37.8975
44388 Colonoscopy A 0059100 $345.49 $170.79 37.8975
44388 Colonoscopy A 0065000 $283.34 $152.24 37.8975


91 Records successfully loaded.

 

[core0]

No, actually, you have it backwards.

This isn't going to look pretty, since I can't paste in a table, but this is directly from the Medicare site (see below). Note that the non-facility price is listed first, the facility price second. The rough averages I quoted were simply from scanning the table. If you want to total them up and divide by 91, please feel free. 😉

Note also that CPT 44388 is for colonoscopy by itself. If you search on additional CPT codes, such as 44392 (colonoscopy with polypectomy), you'll find that the prices are slightly higher for more complex codes.

As for private insurance paying more, that's certainly the case with a lot of payors, but perhaps not with others. At any rate, these figures are not readily available, unlike Medicare fees.

Clinicians would be well-advised to conduct a thorough cost-benefit analysis, including malpractice expenses, before taking on any additional procedures. Fees are only one variable in the equation.

What you are looking at here is the professional fee depending on whether this is done in an ASC or in a hospital outpatient department

44388 Colonoscopy A 0051000 $277.47 $151.15 37.8975

One fee is for procedures done in a HOPD and one in a facility. You get a higher fee for those done in a facility since presumably you have higher overhead. If you own the facilty you also get a facility fee. The real gain is from the increased efficency of having your own facility. At our facility we can do a colonoscopy every 30 min. At the hospital it's every 45-60 min.

Look at this it explains it a little better.
http://www.springerlink.com/content/x613q8044x216666/

Also look at the aga site at www.gastro.org

David Carpenter, PA-C

 

[deleted87716]

What you are looking at here is the professional fee depending on whether this is done in an ASC or in a hospital outpatient department...If you own the facilty you also get a facility fee.

Thanks for clarifying that. The portion of your post that I've highlighted in bold is what I've always understood to be the case, but that apparently doesn't correspond to the fees listed on the Medicare site. I've corrected my original post. This link actually explains it better: http://www.gastro.org/wmspage.cfm?parm1=2302

A colonoscopy with biopsy (45380) performed in a hospital or ASC facility setting is valued less than one performed in a non-facility setting, such as your office. While physician work values are the same (4.43 in 2006), PE differs (1.74 facility versus 7.21 non-facility) to account for the increased equipment and staff overhead of performing the endoscopic service in your office, known as the "Site of Service Differential." Only facilities can submit a UB 92 to Medicare to receive facility fees. For Gastroenterology, the total reimbursement for procedures performed in a facility setting (professional plus facility) is substantially greater than the global reimbursement for non-facility settings, which has led to many GI physicians owning ASC's. In 2003, Congress charged CMS with reviewing the ASC payment methodology; in August 2006 CMS recommended linking ASC reimbursement to a fixed percentage of outpatient hospital reimbursement that would equal 62 percent. As ASC reimbursement for most endoscopic procedures are 88-92 percent of hospital outpatient reimbursement, substantial cuts may occur if this proposal is implemented. The AGA is aggressively advocating for revision of this proposal and for fair payments for gastroenterologists.