Screening colonoscopies in the U.S. cost a total of $23.7 billion in 2021, the most recent available data for nationwide cancer screening costs.
Colorectal cancer rates among U.S. adults have also hit record highs in recent years. The expected growth rate of CRC among U.S. men is 8%, and 7% for women.
In the ASC setting, the average colonoscopy costs $925, compared to $1,224 in the hospital outpatient department. Medicare and private insurers, under the Affordable Care Act, cover a screening colonoscopy, but Medicare patients can expect to pay 15% of the Medicare-approved amount for a physicians' services in a follow-up screening. In the ASC setting, there may also be a 15% coinsurance amount.
But reimbursements for gastroenterologists have steadily declined in recent years. Between 2007 to 2022, unadjusted and adjusted average reimbursement for GI procedures dropped by 7% and 33%, respectively, according to a study published in The American Journal of Gastroenterology. Reimbursements for colonoscopy and biopsy decreased 38% during that period.
In California, Kentucky, Illinois, Nebraska and Vermont, lawmakers are considering or have passed legislation that would expand insurance coverage of colonoscopies. Additionally, in 2021, the National Cancer Institute's recommended screening age for colonoscopies was lowered from 50 to 45, increasing the overall demand for colonoscopies.
"I would love to see payers and clinicians sit down at a table and have a conversation about the benefit of early endoscopy for diagnosis and screening," Omar Khokhar, MD, a gastroenterologist at Illinois GastroHealth in Bloomington, told Becker's. "In particular, how EGD/colonoscopy can potentially prevent patient morbidity and decrease downstream cost to the healthcare system. Yes, endoscopy isn't cheap, but cancer is a bad diagnosis and is more expensive."