Wiki 45388 fees


Port Orange, FL
Best answers
Fellow Members,

Wondered if you could enlighten me as to why CMS has decided that Code 45388:Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is worth $3,000.00 + and any other code within the same range [family] is only valued around $400.00 - $600.00?
I have been contacted by my C-team when they noticed the GI cost was extremely high. Contacted the local MAC First Coast Service Options, they did research and had to rely on the files they received from CMS for the fees, not knowing why it was so out of alignment, or if they knew of the increase. I was referred to the Final Rule for November 2015 which had the Fee schedule changes, nothing relating to the substantial increase in code 45388.
This doesn't seem correct?
We are considering the data input of the RVU is incorrect, however when looking at other MACs they have the same RVU with fees similar to local MAC.
I find it highly irregular that CMS would increase the fee for the same procedure performed in 2014 [45383] from $400.00 +/- to well over $3,000.00 +/- in 2016??

Any assistance with the reasoning behind this would be very helpful and put my administrators [including CMO, and CEO] at ease. If the increase was justified, they would like to know reasoning behind it, if it is an error, we could then proceed to make corrections.

Thank you in advance for your assistance.

Carl W. Costa RHIT, CPC, CDIP
Holly Hill, FL