CPT 45338 Fee Schedule
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.
| 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 • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure • 33 - Preventive Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45338 |
National average reimbursement for CPT 45338 by major payers:
$350.11
$389.27
$434.90
$482.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 45338 | ||||||
United | 45338 | $850.00 | 1245393602 - MARYAM RAHBAR, MD, INC., PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER | 205511930 - (CA) MARYAM RAHBAR MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $445.00 | 1487090452 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $656.00 | 1689163875 - VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC | 825370300 - (IL) VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $707.00 | 1518338052 - CENTER FOR ADVANCED SURGERY LLC | 464112873 - (SC) CENTER FOR ADVANCED SURGERY, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $580.00 | 1346581105 - MD LASER SURGERY CENTER, LLC | 462169227 - (MD) MD LASER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $645.00 | 1194326785 - TEXAS PARTNERS CENTER LLC | 853236752 - (TX) TEXAS PARTNERS CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $555.00 | 1326132291 - MADISON STREET SURGERY CENTER, LLC | 841499650 - (CO) MADISON STREET SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $2157.00 | 1336252402 - ADVANCED ENDOSCOPY CENTER LLC | 10719837 - (NY) ADVANCED ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $980.00 | 1154400471 - ST. LOUIS WOMEN'S SURGERY CENTER, LLC, ST. LOUIS MULTISPECIALTY SURGERY CENTER | 680526281 - (MO) ST LOUIS WOMENS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $939.00 | 1730151168 - HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP, HAWTHORN SURGERY CENTER | 582065044 - (IL) HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $222.57 | 1518639996 - KACI HENRY | 350593390 - DEACONESS HOSPITAL INC | KY | Family Nurse Practitioner (363LF0000X) |
United | 45338 | $1275.00 | 1386381408 - CYPRESS AMBULATORY SURGERY CENTER, LLC, WELLNESS AVENUE SURGERY CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $1631.00 | 1942292545 - CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C. | 141819902 - (NY) CAPITAL REGION AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $735.00 | 1427055425 - PHYSICIANS PAVILION LP, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45338 | $570.00 | 1437115094 - SURGERY CENTER OF LANCASTER, LP | 201824455 - (PA) SURGERY CENTER OF LANCASTER, LP. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 45338 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45338 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 45338 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 |
|---|---|---|
| 45333-CPT | Moderate | Sigmoidoscopy Flexible; With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Hot Biopsy Forceps(Desc Revised 01/01/15) |
| 45338-CPT | Moderate | Sigmoidoscopy, Flexible; With Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique |
| 45346-CPT | High | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Ablation Of Tumor(S), Polyp(S), Or Other Lesions(S) Includ |
| 45380-CPT | Moderate | Colonoscopy, Fiberoptic, Beyond Splenic Flexure; For Biopsy And/Or Collection Of Specimen By Brushing Or Washing |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45338. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45338 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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