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The American Society for Gastrointestinal Endoscopy (ASGE) recognizes that gastrointestinal endoscopy can be safely performed in a variety of settings, including the office, the ambulatory surgical center (ASC) and the hospital outpatient department (HOPD) based on the needs of the patient.

The ASC is a safe, cost-effective site for the provision of high-quality endoscopic procedures when provided by qualified endoscopists following appropriate standards and guidelines.  ASGE recommends that public and private health plans encourage physicians and patients to use the ASC whenever consistent with the patient’s best medical interests.  ASGE supports fair reimbursement for facility services and a flexible regulatory environment that maximizes patient safety, access and innovation.  ASGE opposes artificial restraints, such as Certificate of Need laws or restrictions that inhibit the ability of physicians to build, own and use ASCs.

Third-party payment for care provided in the HOPD, the ASC and the office should reflect the differential costs of providing care in each of these sites of service.  The HOPD and ASC share similar cost components, such as the human resources and equipment required for endoscopic procedures.  However, the HOPD experiences some costs not borne by ASCs and may offer services such as emergency and intensive care not typically available at ASCs.  The HOPD may also be the preferred site of service for patients undergoing urgent procedures, complex procedures or those patients with greater comorbidities undergoing elective procedures.  ASGE considers it appropriate that procedures performed in the HOPD generate higher facility fees than procedures identified by the same Current Procedural Terminology (CPT) codes performed in ASCs.

With advancements in technology, many specialized procedures such as endoscopic ultrasound, and endoscopic mucosal resection, can now be safely provided in the ASC for certain patients at lower cost to the health care system. However, inadequate reimbursement to ASCs have prevented any migration of these services from the hospital outpatient to ASC settings. Much of the cost, which is currently under-reimbursed by Medicare and other payers, of these specialized procedures is associated with the equipment and the accessories used to perform these procedures. This drives providers to unnecessarily perform these procedures in the higher-cost hospital setting.

Approved by the ASGE Governing Board November 2018