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See a sample rate comparisonCPT 45378 Fee Schedule
Medicare rates as of October 2026
CPT 45378 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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 | 33 - Preventive Services SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $378.10 national non-facility rate (2026) · View Medicare rates for 45378 |
| Medicaid Fee Schedule | $295.28 median across 44 state programs · View Medicaid rates for 45378 |
National average reimbursement for CPT 45378 by major payers:
$441.56
BCBS / Anthem
$471.77
UnitedHealthcare
$522.30
Aetna
$331.18
Cigna
Compare published rates across providers.
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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 table lists codes related to 45378. Select one to see its fee schedule.
| 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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Frequently Asked Questions
CPT 45378 reports a diagnostic flexible colonoscopy, including collection of specimens by brushing or washing when performed. It is the base code for colonoscopies where no biopsy or polyp removal is done.
Medicare reports screening colonoscopies with G0121 or, for high-risk patients, G0105. Many commercial plans accept 45378 with modifier 33 for screening. If a biopsy (45380) or snare polypectomy (45385) is performed, that code is reported instead.
Medicare pays CPT 45378 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 45378 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.