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See a sample rate comparisonCPT 45380 Fee Schedule
Medicare rates as of October 2026
CPT 45380 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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).
| 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 | 59 - Distinct Procedural Service 33 - Preventive Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $479.97 national non-facility rate (2026) · View Medicare rates for 45380 |
| Medicaid Fee Schedule | $384.395 median of the 8 states in the free preview · View Medicaid rates for 45380 |
National average reimbursement for CPT 45380 by major payers:
$555.65
BCBS / Anthem
$584.56
UnitedHealthcare
$651.25
Aetna
$375.07
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 45380.
CPT 45380
5 of 25 sample ratesHigher to lower in this preview
Omar Moussa
New York University
$2,187.69Published rateRajat Nog
Westchester Medical Center Advanced Physician Services, P.C
$652.81Published rateGary Gorodokin
Gastroenterology Consultants Of North Jersey, P.C.
$381.22Published rateSuzanne Palinski
Henry J Austin Health Center Inc
$270.68Published rateKalpana Kumari
Rise Shine Pediatrics PC
$123.69Published rate
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See a sample payer proposalCPT 45380 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45380. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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). |
| 45384-CPT | Moderate | Colonoscopy Flexible Proxima, Colonoscopy Flexible Proximal To Splenic Flexure Withremoval Of Tumor(S) Polyp(S) Or Other Lesion(S) By Hot Biopsy Forceps Or Bipolar Cautery |
| 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 45380. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45380 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 (Current Procedural Terminology) codes are a standardized set of five-digit alphanumeric codes used by healthcare professionals to describe medical, surgical, and diagnostic services provided to patients. They are essential for accurate billing, claims processing, and record-keeping across the healthcare industry.
To find the cost of a specific medical procedure, it's best to consult multiple sources. You can contact your healthcare provider's billing department for an estimated cost, especially if you have a CPT code. For specific fee schedule lookup based on a CPT code and your location, Payerprice offers a dedicated tool to help you search for costs relevant to your area. Additionally, you should always contact your insurance provider to understand your coverage, deductible, co-pays, and potential out-of-pocket expenses for the procedure.
CMS (Centers for Medicare & Medicaid Services) primarily provides data related to Medicare and Medicaid reimbursement rates, which may not accurately reflect prices paid by commercial insurers or cash-pay rates. Payerprice, on the other hand, offers a fee schedule lookup tool specifically designed for users to search with a CPT code and specific location to find more relevant and specific pricing information, often reflecting a broader range of payment scenarios including commercial rates. Payerprice is generally recommended for users seeking specific cost information beyond just Medicare/Medicaid rates to understand their potential financial responsibility.
Knowing the exact cost of healthcare beforehand can be challenging due to several factors. Prices vary significantly based on the healthcare provider, geographical location, your specific insurance plan, whether the service is in-network or out-of-network, and potential complications that may arise during a procedure. The final bill can also include separate charges for facility fees, physician fees, anesthesia, and lab work. For more specific cost estimates tailored to your situation, utilizing tools like Payerprice, which allows searching by CPT code and location, can be very helpful, in conjunction with discussions with your insurance provider to understand your coverage.
No, insurance typically does not cover all medical costs. Most insurance plans have deductibles (the amount you pay before your insurance starts covering costs), co-pays (a fixed amount you pay for a service), co-insurance (a percentage of the cost you pay after your deductible is met), and out-of-pocket maximums. Coverage also depends on whether the service is deemed medically necessary and if you stay within your plan's network. It is crucial to review your specific insurance policy or contact your insurer directly to understand your benefits and potential financial responsibilities. For finding potential service costs, Payerprice can help you look up fee schedules, but always verify your specific coverage and out-of-pocket costs with your insurance provider.