Reimbursement differences between hospital outpatient departments and ASCs are a longstanding point of contention among ASC professionals, with Medicare ASC payments increasing only marginally while Medicare hospital pay has seen comparatively significant jumps.
Below are the average Medicare reimbursements for the 10 most common procedures performed at ASCs, using facility and physician fee data from Medicare's Procedure Price Lookup tool.
|
Procedure with HCPCS/CPT code |
ASC facility and physician fee |
HOPD facility and physician fee |
|
1. Excision of cataract with removal of lens, without ECP (66984) |
$1,368 |
$2,198 |
|
2. Colonoscopy, with removal of lesion(s) (45385) |
$685 |
$1,095 |
|
3. Colonoscopy, with biopsy, single/multiple (45380) |
$644 |
$1,054 |
|
4. Esophagogastroduodenoscopy, biopsy, single/multiple (43239) |
$483 |
$797 |
|
5. Diagnostic colonoscopy (45378) |
$521 |
$838 |
|
6. Injection(s), anesthetic agent and/or steroid, lumbar/sacral (64483) |
$464 |
$780 |
|
7. Anesthesia for lower intestine scope, colonoscopy (812) |
Fees not available. |
Fees not available. |
|
8. Injection(s), anesthetic agent and/or steroid, lumbar/sacral (64493) |
$448 |
$764 |
|
9. Destruction of lumbar/sacral facet joint(s) by neurolytic (64635) |
$868 |
$1,621 |
|
10. Incision of eardrum to create opening (69436) |
$659 |
$1,288 |