2015-11-02 14:10:50 UTC

CMS Cuts Reimbursement to Colonoscopy

Nov. 2, 2015

The cuts to the colonoscopy family of codes are inappropriately deep and slash payment for some procedures by more than 17 percent.

Late last week, CMS released the CY 2016 Physician Fee Schedule Final Rule. AGA, ACG and ASGE are outraged at the failure of CMS to accept the GI societies’ reimbursement recommendations. The cuts to the colonoscopy family of codes are inappropriately deep and, at their highest, slash payment for some colonoscopy procedures by more than 17 percent. The cuts proposed in July were as high as 20 percent, and AGA, ACG and ASGE and thousands of our member gastroenterologists advocated strongly against these cuts.

The societies provided research-driven data to support the values recommended by our organizations. The cuts in the final rule were not based on the data submitted; ultimately, our recommendations were disregarded. We intend to shine a light on this fact to Congress and the public.

In the months ahead, we will call on you to reach out to CMS and legislators on Capitol Hill, so that they can better understand the direct impact that these cuts are having on your practice and on patients.

Top 10 Lower GI Codes 

Below is a chart of the top 10 lower GI codes that were cut.

CPT Code Short Descriptor 2015 Physician Work RVU CMS 2016 Proposed Physician Work RVU Proposed RVU % Change CMS 2016 Final Physician work RVU Final RVU % Change
45380 Colonoscopy w/ biopsy 4.43 3.59 -19% 3.66  
45385 Colonoscopy w/ snare polypectomy 5.30 4.67 -12% 4.67 -12%
45373 Colonoscopy 3.69 3.29 -11% 3.36 -9%
G0105 Colorectal cancer screen, high risk 3.36 3.29 -2% 3.36 0%
G0121 Colorectal cancer screen, low risk 3.36 3.29 -2% 3.36 0%
45384 Colonoscopy w/ hot biopsy 4.69 4.17 -11% 4.17 -11%
45381 Colonoscopy w/submucosal injection 4.19 3.59 -14% 3.66 -13%
45388 Colonoscopy, flexible w/ ablation 5.86 4.98 -15% 4.98 -15%
45331 Flexible sigmoidoscopy w/ biopsy 1.15 1.07 -7% 1.14 -1%
45330 Flexible sigmoidoscopy 0.96 0.77 -20% 0.84 -13%
45382 Colonoscopy w/ control of bleeding 5.68 4.76 -16% 4.76 -16%

* 45383 was deleted in CPT 2015 and replaced by 45388. Next week, we will provide a summary of reimbursement changes.

In the coming weeks, we will provide more detailed information and resources to help practices prepare for payment and policy changes. AGA, ACG and ASGE are committed to working together to fight for fair reimbursement for GI procedures. Watch your email for updates on this important issue.

More on Colonoscopy

2018 AGA Postgraduate Course

June 2, 2018

Secure your spot for this clinically focused, multi-topic course that offers immediately applicable information. Held in conjunction with DDW®. Save $75 when you register by April 18.

Choose from 30 breakout sessions at the 2018 AGA Postgraduate Course

March 21, 2018

Delve deeper into specific clinical topics that interest you and get concrete action items that can be immediately implemented into your practice.

Ready for the “Jimmy Kimmel effect”?

March 21, 2018

AGA leader Dr. Christina Ha performed Jimmy Kimmel’s first colonoscopy. Here’s the clip.