The priciest outpatient procedure: The colonoscopy

Colonoscopies are one of the most notoriously uncomfortable procedures for U.S. residents aged 50 to 75. It’s not easy fasting for 24 hours, processing strong laxatives, undergoing a sedation process, and then finding a ride home.  

Unfortunately, the cost of a colonoscopy doesn’t make the procedure any more pleasant. According to New Choice Health out-of-pocket costs for a colonoscopy can range between $1,250 to $4,800. Our own data indicates that the average cost of a colonoscopy (CPT code 45380) is about $2,531.  

More and more patients, however, are booking their colonoscopies at local outpatient facilities (or ambulatory surgery centers), rather than their nearest hospital. We used SurgeryCenterView to look at two trends in colonoscopies.  

Colonoscopy charges continue to lead the pack in 2021 

The chart below compares total charges for some of the most common outpatient procedures performed in ASCs in 2018 and 2021. 

Fig. 1: Data sourced from Definitive Healthcare’s ClaimsMx and SurgeryCenterView products. Data accessed October 2022.  

We can see that colonoscopies continued to have the highest all-payor (including Medicare, Medicaid, and private claims) charges of all ambulatory surgery center procedures. In 2021, the total charges for colonoscopy procedures were more than $11 billion, which is more than three times the total charges in 2018. Colonoscopies are one of the more common procedures older adults undergo. Since doctors recommend all patients over the age of 50 get a colonoscopy every five to ten years, it’s no wonder that this procedure continues to be the leading procedure charge in U.S. ASCs. 

The number of knee surgeries also dramatically increased from 2018 to 2021. One reason behind driving this growth may be the greater number of baby boomers who are now older adults. The University of California Irvine suggests that the greater prevalence of obesity among older adults, alongside a longer life span, means patients are putting more wear and tear on joints such as the hip.  

Top 5 ASCs with the most colonoscopy claims  

Fig. 2: Data sourced from Definitive Healthcare’s ClaimsMx and SurgeryCenterView products. Data accessed October 2022.  

Which ASCs had the most colonoscopy claims? 

Facey Medical Group, located in Mission Hills, California, had the highest percentage of colonoscopy procedures in 2021, at 18.70%. Ranked second is The Surgery Center at Orthopedic Associates in Poughkeepsie, NY. This facility performed 16.80% of colonoscopy procedures. And third is the Southern Illinois Orthopedic Center, accounting for 12% of colonoscopy procedures performed in 2021.  

The geographical territories these ASCs cover may be a factor behind why these particular facilities ranked highest in the U.S. in 2021. California, New York, Illinois, and Florida are all among the most populous states in the country. And according to the Population Reference Bureau, roughly one-fourth of all older adults in the U.S. live in one of these states.   

How long does a colonoscopy take? 

Under most circumstances, a colonoscopy can be done as an outpatient procedure, meaning the patient doesn’t need to stay overnight in a hospital or facility. The Mayo Clinic states that colonoscopies typically take about 30 to 60 minutes to complete.  

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