CPT 45378 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 • 33 - Preventive Services • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| CMS | $164.00 Physician Fee Schedule |
National average reimbursement for CPT 45378 by major payers:
$441.56
$471.77
$522.30
$569.58
| 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 45378 | ||||||
United | 45378 | $658.50 | 1598249484 - DANIEL IANNELLO | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Physician Assistant (363A00000X) |
United | 45378 | $1278.56 | 1083371132 - PATRICK FRANCIS | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Surgical Physician Assistant (363AS0400X) |
United | 45378 | $1504.20 | 1093700031 - MAUD LEMERCIER | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Surgery Physician (208600000X) |
United | 45378 | $597.04 | 1831459916 - RANI MODAYIL | 135562308 - NEW YORK UNIVERSITY | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $631.34 | 1891173514 - YERA PATEL | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Internal Medicine Physician (207R00000X) |
United | 45378 | $225.36 | 1255573671 - ASHLEY MARANINO | 134185781 - (NY) SJR MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $391.39 | 1841278017 - DIAHANN SEAMAN | 274181529 - (NY) HARLEM MEDICAL ASSOCIATES PC | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $285.98 | 1639268105 - KONSTANTIN VAIZMAN | 834094689 | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $313.54 | 1467436501 - MAURICIO HERNANDEZ | 650785111 | FL | Specialist (174400000X) |
United | 45378 | $535.04 | 1821528910 - JUN ZHU ZHANG | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Physical Therapist (225100000X) |
United | 45378 | $838.66 | 1720080252 - ADENA BURNSTEIN | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Anesthesiology Physician (207L00000X) |
United | 45378 | $40.00 | 1003019449 - GINGER FITNESS AND REHABILITATION INC | 421530390 - (FL) GINGER FITNESS AND REHABILITATION INC | FL | Specialist (174400000X) |
United | 45378 | $357.67 | 1063502235 - ANDREW TALAL | 160743187 - (NY) SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $490.86 | 1023085123 - RADIOLOGY ASSOCIATES OF MIAMI BEACH PA | 650994853 - (FL) RADIOLOGY ASSOCIATES OF MIAMI BEACH, P.A. | FL | Specialist (174400000X) |
United | 45378 | $224.75 | 1528098118 - CARL GUILLAUME | 262583753 | NY | Gastroenterology Physician (207RG0100X) |
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 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 | Sigmoidoscopy Flexible; Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) (Desc Revised 01/01/15) |
| 45378-CPT | Moderate | Colonoscopy Flexible Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) (Desc Revised 01/01/15) |
| 45380-CPT | Moderate | Colonoscopy, Fiberoptic, Beyond Splenic Flexure; For Biopsy And/Or Collection Of Specimen By Brushing Or Washing |
| 45388-CPT | High | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed, With Ablation Of Tumors, Polyss, Or Other Lesionss Includ |
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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