CMS pay for 10 GI procedures at ASCs vs. HOPDs

Alan Condon - Print  |

CMS' procedure price look-up tool allows users to compare average pay for several procedures in ASCs and hospital outpatient departments.

The tool shows national averages for the amount Medicare pays an ASC or hospital, and the national average copayment a patient without Medicare supplemental insurance owes in each setting.

Here's what 10 gastroenterology procedures cost at ASCs and hospital outpatient departments:

1. Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, Stamm procedure) (separate procedure) (Code: 43653)

ASC
Total Cost: $2,902
Medicare pays: $2,322
Patient pays: $580

HOPD
Total cost: $5,657
Medicare pays: $4,526
Patient pays: $1,131

2. Closure of gastrostomy, surgical

ASC
Total Cost: $2,107
Medicare pays: $1,685
Patient pays: $420

HOPD
Total cost: $3,813
Medicare pays: $3,050
Patient pays: $762

3. Gastrocnemius recession (Code: 27687)

ASC
Total Cost: $1,794
Medicare pays: $1,434
Patient pays: $358

HOPD
Total cost: $3,296
Medicare pays: $2,636
Patient pays: $659

4. Colonoscopy, flexible; with endoscopic mucosal resection (Code: 45390)

ASC
Total Cost: $1,484
Medicare pays: $1,186
Patient pays: $296

HOPD
Total cost: $2,780
Medicare pays: $2,223
Patient pays: $555

5. Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) (separate procedure) (Code: 43830)

ASC
Total Cost: $1,415
Medicare pays: $1,131
Patient pays: $282

HOPD
Total cost: $2,351
Medicare pays: $1,881
Patient pays: $470

6. Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube (eg, Celestin or Mousseau-Barbin) (Code: 43510)

ASC
Total Cost: $1,390
Medicare pays: $1,112
Patient pays: $277

HOPD
Total cost: $1,790
Medicare pays: $1,432
Patient pays: $357

7. Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report (Code: 49440)

ASC
Total Cost: $894
Medicare pays: $715
Patient pays: $178

HOPD
Total cost: $1,830
Medicare pays: $1,464
Patient pays: $366

8. Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

ASC
Total Cost: $844
Medicare pays: $675
Patient pays: $168

HOPD
Total cost: $1,780
Medicare pays: $1,424
Patient pays: $356

9. Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed (Code: 45393)

ASC
Total Cost: $781
Medicare pays: $624
Patient pays: $155

HOPD
Total cost: $1,293
Medicare pays: $1,034
Patient pays: $258

10. Colonoscopy, flexible; with biopsy, single or multiple (Code: 45380)

ASC
Total Cost: $728
Medicare pays: $582
Patient pays: $144

HOPD
Total cost: $1,240
Medicare pays: $992
Patient pays: $246

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