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See a sample rate comparisonCPT 45349 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.
Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Endoscopic Mucosal Resection.
| 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 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 45349 |
| Medicaid Fee Schedule | View Medicaid rates for 45349 |
National average reimbursement for CPT 45349 by major payers:
$275.41
$279.61
$343.66
$346.04
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CPT 45349
5 of 25 sample ratesHigher to lower in this preview
Toms River Surgery Center, LLC, Toms River Surgery Center
Toms River Surgery Center LLC
$3,446.00Published rateCapital Region Ambulatory Surgery Center, L.L.C.
Capital Region Ambulatory Surgery Center LLC
$1,631.00Published rateBlue Ridge Day Surgery Center, Lp, Blue Ridge Day Surgery Center
Blue Ridge Day Surgery Center Lp
$1,200.00Published rateSouth Meadows Endoscopy Center, LLC
South Meadows Endoscopy Center LLC
$776.02Published rateKirurgs, LLC, Surgeons' Surgical Center
Surgeons Surgical Center, LLC
$425.00Published rate
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See a sample payer proposalCPT 45349 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45349 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 45349 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 |
|---|---|---|
| 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. |
| 45349-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Endoscopic Mucosal Resection. |
| 45385-CPT | Moderate | Colonoscopy To Remove Growth, An Exam Of The Intestine Using A Scope (Colonoscopy). The Procedure Includes Removing One Or More Tissue Growths Such As A Tumor Or Polyp. |
| 45390-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Endoscopic Mucosal Resection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45349. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45349 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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