Which colonoscopy and endoscopy codes appear most often in federal IDR?

Upper endoscopy with biopsy (43239) leads with 1,059 of the 3,032 procedure disputes in the 2025 files, followed by colonoscopy with biopsy (45380) with 481, diagnostic upper endoscopy (43235) with 302, colonoscopy with snare polyp removal (45385) with 294, and diagnostic colonoscopy (45378) with 280.

Do procedure and sedation codes win at the same rate?

Procedure codes won a little more often. In 2025 providers won between 88.15 and 90.78 percent of disputes by colonoscopy biopsy, snare, and diagnostic code, and between 79.57 and 85.66 percent of disputes by endoscopy anesthesia code.

Answers / What the codes pay

What colonoscopy and endoscopy codes pay in federal IDR

Q: What do endoscopy sedation codes pay in federal IDR?

In 2025, anesthesia for a screening colonoscopy (00812) had a median QPA of $247.22 and a median decided award of $1,620.00 across 45,298 lines, upper endoscopy anesthesia (00731) $288.91 and $1,604.12, and the combined code (00813) $316.75 and $1,981.00.

In 2025 No Surprises Act arbitration, upper endoscopy with biopsy (43239) was the most disputed GI procedure code, with 1,059 disputes, an 87.23 percent provider win rate, a median QPA of $212.12, and a median decided award of $15,000.00. Colonoscopy codes decided between $12,000.00 and $18,000.00 against QPAs of $330.59 to $494.93, while the four common endoscopy anesthesia codes decided between $1,512.00 and $1,981.00 against QPAs of $247.22 to $316.75. These are medians of lines that report a QPA and offers.

Colonoscopy codes

Colonoscopy with biopsy (45380) appeared in 481 procedure disputes in 2025 and providers won 88.15 percent, with a median QPA of $330.59 and a median decided award of $18,000.00 across 393 lines that report a QPA and offers. Colonoscopy with snare polyp removal (45385) appeared in 294 disputes (90.78 percent won; $494.93 and $18,000.00 across 199 lines) and diagnostic colonoscopy (45378) in 280 (88.93 percent; $337.14 and $12,000.00 across 189). Rigid proctosigmoidoscopy (45300), a limited exam of the rectum and lower colon, appeared in 198 disputes with a 95.45 percent provider win rate, a median QPA of $35.43, and a median award of $8,893.96 across 178 lines. A dispute can list a code on more than one line: 45378 appears on 321 lines across its 280 disputes.

Upper endoscopy codes

Upper endoscopy with biopsy (43239) is the most disputed GI procedure code, with 1,059 disputes (87.23 percent won), a median QPA of $212.12, and a median decided award of $15,000.00 across 912 lines. Upper endoscopy with snare removal of a lesion (43251) appeared in 83 disputes (85.54 percent won; $271.26 and $21,500.00 across 54 lines), the highest median award among the GI procedure codes listed here. Diagnostic upper endoscopy (43235) decided far lower: 302 disputes (83.0 percent won), a median QPA of $287.54, and a median award of $3,000.00 across 195 lines. Upper endoscopy with feeding tube placement (43246) appeared in 62 disputes, and providers won 77.42 percent, the lowest rate among the upper endoscopy codes.

Sedation codes

Anesthesia for a screening colonoscopy (00812) appeared in 28,711 sedation disputes and providers won 83.1 percent, with a median QPA of $247.22 and a median decided award of $1,620.00 across 45,298 lines. Upper endoscopy anesthesia (00731) appeared in 14,893 disputes (83.05 percent won; $288.91 and $1,604.12 across 19,876 lines), the combined upper and lower code (00813) in 10,861 (82.69 percent; $316.75 and $1,981.00 across 14,840), and lower endoscopy anesthesia (00811) in 10,555 (79.57 percent; $271.05 and $1,512.00 across 12,804). Anesthesia for ERCP (00732) appeared in 1,374 disputes with the highest win rate of the group, 85.66 percent, and the highest median QPA, $428.84, against a median award of $1,631.26 across 1,304 lines. Other anesthesia codes that share these disputes won less often: lower abdominal laparoscopy anesthesia (00840) in 173 disputes at a 60.12 percent provider win rate, and upper abdominal laparoscopy anesthesia (00790) in 138 at 60.14 percent.

Reading the medians

Each median covers lines that report a QPA and offers, so lines with no QPA or no offers, such as default decisions, are left out. Procedure awards sit far above the QPAs: winning offers came in at a median 46.44 times the QPA in procedure disputes against 7.98 in sedation disputes. One filer domain brought 63.8 percent of the procedure disputes and California 58.4 percent, so a procedure median describes that cohort's claims more than the national picture. The payer and state cuts are at idrexplorer.com, and Lido IDR prices each code against them before filing for a flat fee per arbitration.

Price your GI codes against the record

Lido IDR sets an offer for each colonoscopy, endoscopy, and sedation code from the decided results for your payers and states, then files for a flat fee per arbitration. Talk to an IDR specialist.