45378

Diagnostic examination of large bowel using endoscope

Our Work > Good Faith Estimates > Diagnostic Examination of Large Bowel

Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Diagnostic examination of large bowel using endoscope appears on both lists, and there is a standard service package available for it.

This service consists of a colonoscopy to examine the inner lining of the colon and rectum, which make up the large intestine. In this procedure, a long, flexible, lighted tube with a tiny camera attached to the end is inserted into the rectum. An esophagogastroduodenoscopy (EGD), a test to examine the lining of the esophagus, stomach, and first part of the small intestine, may also be performed at the same time as this procedure. Additional tests, including pathology,  may also be performed.

Your service utilization may vary from this service package for a number of reasons, including your unique clinical profile and where you receive your services. We include an optional fee for an EGD and a pathology service.  However, note that other services may be performed which are not included in this service package.

This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.

  • Inpatient:Discuss with your provider
  • Outpatient facility: 50%
  • Free standing ASC: 50%
  • Office: Discuss with your provider

Item Definitions

Index

Index

this is the fee for the service being defined; note that other codes may be used to define a similar service

Facility Fee

Facility Fee

these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee

Professional Fee

Professional Fee

these fees are paid to clinicians for the work associated with this service

Optional Fee

Optional Fee

these services are often also billed with the index event, however may vary based on the patient’s individual circumstances

Ancillary Service

Ancillary Service

these are supply codes that identify other services that may be billed with the index event

Proposed Technical Definition

associationbase_codecode_typeestimated_chargeitem_typename
145378CPT2707facility_feeDiagnostic examination of large bowel using endoscope
145378CPT850professional_feeDiagnostic examination of large bowel using endoscope
812CPT$400professional_feeAnesthesia
0.737980048636Revenue Codefacility_feeDrugs requiring detailed coding
0.68169981750Revenue Codefacility_feeGastrointestinal services
0.465726394J2704HCPCS51.21facility_feePropofol injection
0.313005482370Revenue Codeancillary_serviceAnesthesia
710Revenue Codeancillary_serviceRecovery Room
250Revenue Codeancillary_servicePharmacy
0.30302356J2250HCPCS$20facility_feeMidazolam hydrochloride injection
43239$1,000optional_fee [facility]Multiple procedure
43239$150optional_fee [professional]Multiple Procedure
88305$150optional_fee [professional]Pathology
88305$200optional_fee [facility]Pathology

Captured Spending (N=400,000)

Decile Base Fee (Facility + Professional) Base Fee + Optional Fees
1 1% 1%
2 0% 0%
3 1% 0%
4 5% 1%
5 2% 1%
6 4% 1%
7 5% 1%
8 2% 3%
9 4% 5%
10 76% 88%

Our Work > Good Faith Estimates > Diagnostic Examination of Large Bowel

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