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See a sample rate comparisonCPT 45342 Fee Schedule
Last Verified: September 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.
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 | None AG - Primary physician GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45342 |
| Medicaid Fee Schedule | View Medicaid rates for 45342 |
National average reimbursement for CPT 45342 by major payers:
$240.96
$261.76
$264.72
$302.84
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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 CPT 45342 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 45342 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 |
|---|---|---|
| 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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