Diagnostic examination of large bowel using endoscope
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
this is the fee for the service being defined; note that other codes may be used to define a similar service
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
these fees are paid to clinicians for the work associated with this service
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
|1||45378||CPT||2707||facility_fee||Diagnostic examination of large bowel using endoscope|
|1||45378||CPT||850||professional_fee||Diagnostic examination of large bowel using endoscope|
|0.737980048||636||Revenue Code||facility_fee||Drugs requiring detailed coding|
|0.68169981||750||Revenue Code||facility_fee||Gastrointestinal services|
|710||Revenue Code||ancillary_service||Recovery Room|
|0.30302356||J2250||HCPCS||$20||facility_fee||Midazolam hydrochloride injection|
|43239||$1,000||optional_fee [facility]||Multiple procedure|
|43239||$150||optional_fee [professional]||Multiple Procedure|
Captured Spending (N=400,000)
|Decile||Base Fee (Facility + Professional)||Base Fee + Optional Fees|