Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America

Table 1 Billing data for endoscopic submucosal dissection-related endoscopic procedures

Total patients	120
Gender	Male 64; female 56
Type of GI endoscopy	Lower 76; upper 44
Age (yr)	Range 22-92
Indication of procedure	Mucosal polyps/lesions 81, submucosal lesions 15, myotomy 24
Length of ESD (min)	Range 20-120
Complications	3 (2.5%) (2 post-ESD bleed; 1 esophageal stricture requiring dilation)
Type of health insurance	Commercial 52 (43%), medicare 49 (40.8%), HMO 19 (15.8%)
Not paid as unlisted CPT	42
Initial denial rate	35%
Not paid at all	10
Final denial rate	8.33%
Number of denials	Range 0 to 9

GI: Gastrointestinal; ESD: Endoscopic submucosal dissection; CPT: Current procedural terminology.