Costs and repeat rates associated with colonoscopy observed in medical claims for commercial and Medicare populations

Table 3 Analysis of screening colonoscopies, medicare population

Code	Screening colonoscopies,% N = 56,496	Average per colonoscopy
		Allowed	Paid	Cost share	Coinsurance%
		$	$	$	Coinsurance%
All screening colonoscopies	100	1,071	795	275	25.7
Colonoscopies with no modifiers	86.3	1,073	795	278	25.9
45378	4.8	836	606	229	27.5
45380	22.5	1,057	784	272	25.8
45383	2.6	1,240	917	323	26.1
45384	8.2	1,139	834	305	26.8
45385	35.7	1,196	889	307	25.7
G0121	12.4	762	564	198	26.0
Colonoscopies with modifiers	0.8	849	623	225	26.6
22, 52, 53, 73, and 74 *	0.8	849	623	225	26.6
Colonoscopies with other modifiers	13.0	1,067	808	258	24.2

* 22 = Service provided is greater than that usually required for the listed procedure.
52 = A service or procedure is partially reduced at the physician’s discretion.
53 = Termination of a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well-being of the patient.
73 = Discontinued outpatient hospital/ambulatory surgery center procedure prior to the administration of anesthesia.
74 = Discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia.

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