Specialty rate rollup
Gastroenterology
Endoscopic procedures (colonoscopy, upper endoscopy, and capsule studies) alongside office visits.
This is a curated starter set for comparison. It doesn't claim that every specialty bills every code, and it isn't a utilization-weighted average.
At a glance
Q4 2019 compared with the prior available PFS release.
Conversion factor: 0.0% no change
Payable codes
7 / 7
Changed this release
0
Largest increase
None
Largest decrease
None
See the rates where you practice
Enter a ZIP code to apply that Medicare locality’s work, practice-expense, and malpractice adjustments to every row.
Current national rates Copy link
Q4 2019 releaseOffice (non-facility) and facility professional amounts, GPCI 1.000, before sequestration.
| Code and service | Status | Office (non-facility) | Facility |
|---|---|---|---|
| Visits and evaluation | |||
| 99213 Routine Follow-Up Office Visit | Active |
$75.32
No price history
|
$51.90
No price history
|
| 99214 Long Follow-Up Office Visit | Active |
$110.28
No price history
|
$80.01
No price history
|
| Surgical and endoscopic procedures | |||
| 45378 Diagnostic Colonoscopy | Active |
$330.84
No price history
|
$194.97
No price history
|
| 45380 Colonoscopy With Tissue Sampling | Active |
$424.90
No price history
|
$211.55
No price history
|
| 43235 | Active |
$274.26
No price history
|
$129.02
No price history
|
| 43239 Upper Gastrointestinal Endoscopy With Tissue Sampling | Active |
$367.24
No price history
|
$145.96
No price history
|
| Testing and diagnostics | |||
| 91110 | Active |
$900.26
No price history
|
$900.26
No price history
|
Every code links to its contracted-rate (% of Medicare) table and a full RVU breakdown, plus billing-policy context and rate history.
How often these codes appear in Medicare Copy link
Across Original Medicare nationally in CY2024, the covered codes on this page accounted for the activity below. It counts use by clinicians of every specialty, not just Gastroenterology, and CMS publishes it on a different cycle from the fee schedule.
Services
176.5M
Times these codes were billed
Allowed dollars
$18.7B
Across covered Medicare FFS services
Most used in this set
99214
103.7M services
Coverage: 7 of 7 displayed codes. HCPCS Level II and excluded drug codes may not appear in this utilization dataset.
What this specialty actually bills Medicare
Observed CY2024 Medicare fee-for-service billing by Gastroenterology clinicians, grouped by CMS rendering-provider specialty. That grouping differs from this page's Gastroenterology label, so treat it as context for the curated list above.
| Top codes by allowed dollars | Share of allowed | Allowed |
|---|---|---|
| 45385 not in the list above | 16.3% | $221.0M |
| 99214 | 12.5% | $169.8M |
| 43239 | 7.2% | $97.4M |
| 45380 | 6.6% | $89.9M |
| J3380 not in the list above | 6.5% | $88.0M |
| 99204 not in the list above | 5.8% | $78.4M |
| 99213 | 5.4% | $73.2M |
| 99232 not in the list above | 3.8% | $51.4M |
| 99222 not in the list above | 3.1% | $41.6M |
| G0105 not in the list above | 2.4% | $33.0M |
| Top codes by services | Share of services | Services |
|---|---|---|
| J3380 not in the list above | 23.1% | 4.1M |
| 99214 | 7.6% | 1.3M |
| 43239 | 5.7% | 1.0M |
| 45385 not in the list above | 5.1% | 891,610 |
| 99213 | 4.6% | 811,382 |
| 45380 | 4.1% | 720,078 |
| 99232 not in the list above | 3.7% | 648,235 |
| J1745 not in the list above | 2.7% | 480,212 |
| 99204 not in the list above | 2.7% | 472,046 |
| 88305 not in the list above | 2.0% | 348,603 |
Localis can price 54% of this cohort's observed services (88% of allowed dollars) under the Q4 2019 release. The rest is clinical lab, drugs, or services paid outside the PFS under other fee schedules, not $0.
Established patient office visits—Office (non-facility)
Visit levels as shares of the 2024 services observed in this family, across 11,280 clinicians.
New patient office visits—Office (non-facility)
Visit levels as shares of the 2024 services observed in this family, across 9,571 clinicians.
Also high-volume for this cohort (observed, not yet in the curated list above)
This is observed billing only. The curated table above is still this page's rate list.
CY2024 Medicare fee-for-service only. Codes billed by fewer than 30 observed clinicians in a single setting are not shown, so shares may not total 100%. CMS publishes only a facility vs non-facility split, not exact places of service. Observed use adds context to the curated table above. It doesn't weight or change any rate on this page.
Turn the list into contract math
Analyze a payer offer using these Gastroenterology codes
We’ll preload the code set in Contract Check. Add your annual volumes and ZIP to see the volume-weighted percentage of Medicare and annual-dollar difference.
Get notified when Gastroenterology rates change
Medicare updates the fee schedule every quarter. We'll email you only when a release moves one of the 7 Gastroenterology codes on this page.
Did this answer your question about Gastroenterology?
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Source & method Copy link
Amounts are computed from the CMS Medicare Physician Fee Schedule Q4 2019 release, GPCI 1.000, before the ~2% sequestration cut. The grouping by common clinical scenario is our own, not the AMA’s code-family taxonomy, and it’s a curated starter set, not a utilization-weighted specialty mix. A code with no amount is either not separately payable under the PFS or absent from the release. It never means $0.