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See a sample rate comparisonCPT 45342 Fee Schedule
Medicare rates as of October 2026
CPT 45342 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Biopsy Of Large Intestine, An Exam Of The Lower Portion Of The Large Intestine Using A Scope (Sigmoidoscopy). The Procedure May Use Ultrasound (Sound Wave Images) To Guide Removal Of A Sample Of Tissue For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | AG - Primary physician GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $151.64 national non-facility rate (2026) · View Medicare rates for 45342 |
| Medicaid Fee Schedule | $137.86 median of the 8 states in the free preview · View Medicaid rates for 45342 |
National average reimbursement for CPT 45342 by major payers:
$240.96
BCBS / Anthem
$261.76
UnitedHealthcare
$264.72
Aetna
$302.84
Cigna
Compare published rates across providers.
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CPT 45342
5 of 25 sample ratesHigher to lower in this preview
Lafayette Surgery Center Limited Partnership
$2,347.00Published rateNorthern California Advanced Surgery Center Lp
Northern California Advanced Surgery Center, Lp
$825.00Published rateSurgcenter Of Western Maryland, LLC
$644.00Published rateVan Dyck Asc, LLC
Van Dyck Asc LLC
$524.00Published rateSt Lukes Surgical Center Inc, St. Luke'S Surgical At Wesley Chapel
St Lukes Surgical Center Inc
$350.00Published rate
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See a sample payer proposalCPT 45342 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45342. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 45342-CPT | Moderate | Biopsy Of Large Intestine, An Exam Of The Lower Portion Of The Large Intestine Using A Scope (Sigmoidoscopy). The Procedure May Use Ultrasound (Sound Wave Images) To Guide Removal Of A Sample Of Tissue For Testing (Biopsy). |
| 45389-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed, With Endoscopic Stent Placement Includes Pre And Post Dilation |
| 45391-CPT | Moderate | Colonoscopy W Endoscope Us, Colonoscopy Flexible With Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures |
| 45392-CPT | Moderate | Colonoscopy W Endoscopic Fnb, Colonoscopy Flexible With Transendoscopic Ultrasound Guided Intramural Or Transmural Fine Needle Aspiration Biopsy S Includes Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45342 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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