Table 2.
Costs ($US) employed in the model
| Cumulative charges to CMS ($) | Range ($) | |
|---|---|---|
| EGD with dilation over guidewire (CPT 43248) | 804†‡ (192 M.D. and 612 facility fees) | 700–1900 |
| EGD with control of bleeding, any method (CPT 43255) | 900†‡ (288 M.D. and 612 facility fees) | 700–1900 |
| 6-week course of fluticasone (220 mcg inhaler, 4 puffs swallowed twice daily) | 740.97§ | 500–1500 |
| Nystatin oral suspension (60 cc bottle) | 39.99§ | 20–60 |
| 1-night inpatient admission for GI bleeding | 14 733¶ | 5000–30 000 |
| 5-night inpatient admission for esophageal perforation (not requiring surgical repair) | 38 139¶ | 10 000–100 000 |
CMS 2010 rates (Hospital outpatient payment + MD payment in-facility):
†
PFS Relative Value File RVU11AR December 30, 2010. National Average Medicare physician payment rates calculated using a conversion factor of $33.9764.
‡
Source: November 24, 2010 Federal Register.
¶
Source: Vanderbilt University Medical Center institutional finance officer.
CMS, Center for Medicare and Medicaid Services; CPT, current procedural terminology; EGD, esophagogastroduodenoscopy; GI, gastrointestinal.