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See a sample rate comparisonCPT 45378 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.
Colonoscopy Flexible Proxima, Colonoscopy Flexible Proximal To Splenic Flexurediagnostic With Or Without Collection Of Specimen(S) By Brushing Or Washing With Or Without Colon Decompression
| 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 33 - Preventive Services SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45378 |
| Medicaid Fee Schedule | View Medicaid rates for 45378 |
National average reimbursement for CPT 45378 by major payers:
$441.56
$471.77
$522.30
$331.18
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CPT 45378
5 of 25 sample ratesHigher to lower in this preview
Jonas Nelson
Mskcc Surgery Group
$1,760.14Published rateMichael Ronan
Caremount Medical, P.C.
$631.34Published rateBrittany Dee Mueller
Atlantic Health System Inc
$577.17Published rateTimothy Wong
Advanced Gastroenterology Practice, PLLC
$358.51Published rateFirpo Guerrero
Essex Gastro Associates, PA
$237.05Published rate
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See a sample payer proposalCPT 45378 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45378 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 45378 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). |
| 45378-CPT | Moderate | Colonoscopy Flexible Proxima, Colonoscopy Flexible Proximal To Splenic Flexurediagnostic With Or Without Collection Of Specimen(S) By Brushing Or Washing With Or Without Colon Decompression |
| 45380-CPT | Moderate | Intestinal Exam (Colonoscopy), An Exam Of The Lower Part Of The Intestine (Colon) Using A Scope (Colonoscopy). The Procedure May Include Collection Of Cells Or Tissue For Testing (Biopsy). |
| 45398-CPT | Moderate | Colonoscopy Hemorrhoid Band, An Exam Of The Intestine With A Scope (Colonoscopy). The Procedure Includes Stopping The Flow Of Blood To A Hemorrhoid Using A Band. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45378. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45378 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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