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 | Endoscopy Procedures on the Rectum Surgical Procedures on the Colon and Rectum |
| 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 |
National average reimbursement for CPT 45378 by major payers:
$441.56
$471.77
$522.30
$331.18
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 45378 | $577.17 | 1063944650 - BRITTANY DEE MUELLER | 202088165 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 45378 | $313.54 | 1467436501 - MAURICIO HERNANDEZ | 650785111 | FL | Specialist (174400000X) |
United | 45378 | $1202.43 | 1841261534 - HEATHER WARGO | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Urology Physician (208800000X) |
United | 45378 | $460.45 | 1730251141 - MARIA FEDERICO | 202088165 - ATLANTIC HEALTH SYSTEM INC | NJ | Nurse Practitioner (363L00000X) |
United | 45378 | $1241.94 | 1912598467 - NICHOLAS MALIZIA | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Physician Assistant (363A00000X) |
United | 45378 | $365.35 | 1255334991 - JUAN GARCIA | 262050656 - (FL) MIAMI CARDIOVASCULAR SPECIALISTS PA | FL | Specialist (174400000X) |
United | 45378 | $624.46 | 1598023459 - ADVOCARE, LLC, ADVOCARE AROESTY EAR, NOSE & THROAT ASSOCIATES | 223537011 - ADVOCARE, LLC | NJ | Otolaryngology Physician (207Y00000X) |
United | 45378 | $279.19 | 1700830098 - MICHAEL HERNANDEZ | 273774869 - NEW YORK CARDIOVASCULAR SURGICAL ASSOCIATES LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 45378 | $418.26 | 1376781567 - KELLEY YAN | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $631.34 | 1194897389 - MICHAEL RONAN | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Pediatrics Physician (208000000X) |
United | 45378 | $358.51 | 1275731739 - TIMOTHY WONG | 274775263 - (NY) ADVANCED GASTROENTEROLOGY PRACTICE, PLLC | NY | Gastroenterology Physician (207RG0100X) |
United | 45378 | $366.79 | 1033663604 - NOREEN GOMILLION | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Physician Assistant (363A00000X) |
United | 45378 | $237.05 | 1518973742 - FIRPO GUERRERO | 222732134 - ESSEX GASTRO ASSOCIATES, PA | NJ | Gastroenterology Physician (207RG0100X) |
United | 45378 | $1760.14 | 1083932073 - JONAS NELSON | 134010372 - MSKCC SURGERY GROUP | NY | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 45378 | $339.11 | 1467422642 - MARTIN SHILL | 991355306 | NV | 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 Colon and Rectum Codes
The CPT 45378 code is part of the Endoscopy Procedures on the Rectum services used for Surgical Procedures on the Colon and Rectum. 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). |
| 45388-CPT | High | Colonoscopy To Remove Tissue, An Exam Of The Lower Part Of The Large Intestine (Colon) Using A Scope (Colonoscopy). The Procedure Removes Abnormal Tissue Growths Such As Tumors Or Polyps. |
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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