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See a sample rate comparisonCPT 45331 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Colonoscopy For Biopsy, An Exam Of The Lower Part Of The Large Intestine (Colon) Using A Scope (Sigmoidoscopy). The Procedure Takes A Sample Of Tissue For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45331 |
| Medicaid Fee Schedule | View Medicaid rates for 45331 |
National average reimbursement for CPT 45331 by major payers:
$284.05
$308.23
$359.42
$144.38
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CPT 45331
5 of 25 sample ratesHigher to lower in this preview
Ocean Surgical Pavilion, PC, Ocean Surgical Pavilion
$1,379.00Published rateThe Westlake Ophthalmology Asc, LLC, Westlake Eye Surgery Center
The Westlake Ophthalmology Asc LLC
$580.00Published rateStephen Heinrich
The Administrators Of The Tulane Educational Fund
$300.39Published rateJeffrey Sketchler
Lmg, LLC
$182.94Published ratePrimary Care Physicians, Inc.
Primary Care Physicians Inc
$48.72Published rate
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See a sample payer proposalCPT 45331 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45331 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 45331 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 45330-CPT | Low | Scope Exam Of Large Intestine, An Exam Of The Large Intestine Using A Scope (Sigmoidoscopy). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 45331-CPT | Moderate | Colonoscopy For Biopsy, An Exam Of The Lower Part Of The Large Intestine (Colon) Using A Scope (Sigmoidoscopy). The Procedure Takes A Sample Of Tissue For Testing (Biopsy). |
| 45338-CPT | Moderate | Colonoscopy To Remove Tissue, An Exam Of The Lower Part Of The Large Intestine (Colon) Using A Scope (Sigmoidoscopy). The Procedure Removes Abnormal Tissue Growths Such As Tumors Or Polyps. |
| 45341-CPT | Low | Sigmoidoscopy Flexible Diagn, Sigmoidoscopy Flexible Diagnostic With Or Woutcollection Of Specimen(S) By Brushing Or Washing (Separate Procedure) With Endoscopic Ultrasound Examination. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45331. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45331 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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