What is CPT code 45380?

CPT code 45380 is used for a 'Colonoscopy, Fiberoptic, Beyond Splenic Flexure; For Biopsy And/Or Collection Of Specimen By Brushing Or Washing'. Healthcare providers use this code for visits involving moderate-level medical decision-making, multiple diagnoses, or prescription management.

What factors affect fee schedules?

Fee schedules are influenced by several factors, including Medicare & Medicaid rates (government-set), Private Insurance Rates (negotiated between providers and insurers), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital vs. private practice).

How does CPT 45380 compare to other digestive system procedure codes?

CPT 45380 is part of the Surgery services for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter, involving more provider time and moderate medical decision-making compared to lower-level codes like 45338, 45378, or 45379.

How can PayerPrice help with CPT 45380 fee schedules?

PayerPrice allows users to benchmark CPT 45380 rates against market averages to identify opportunities for rate optimization, prospect for new business using fee schedules, and integrate real-time payer data into workflows. It provides exact negotiated rates published by insurers under federal transparency rules.

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.

How can I find the cost of a medical procedure?

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.

What is the difference between Payerprice and CMS for price lookup?

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.

Why is it difficult to know the exact cost of healthcare beforehand?

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.

Does insurance cover all medical costs?

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.

CPT 45380 Fee Schedule

Last Verified: July 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.

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	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 59 - Distinct Procedural Service 33 - Preventive Services
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 45380

National average reimbursement for CPT 45380 by major payers:

$555.65

$584.56

$651.25

$375.07

Preview provider-level rates for...

For billing codeCPT 45380

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	45380	$317.69	1730184318 - JOEL LANDZBERG	223005844 - PVH CARDIAC TESTING GROUP PA	NJ	Cardiovascular Disease Physician (207RC0000X)
United	45380	$2187.69	1164919551 - OMAR MOUSSA	135562308 - NEW YORK UNIVERSITY	NY	Hospitalist Physician (208M00000X)
United	45380	$270.68	1124041538 - SUZANNE PALINSKI	222682708 - HENRY J AUSTIN HEALTH CENTER INC	NY	Pediatrics Physician (208000000X)
United	45380	$327.86	1205818135 - NAZIA RIZVI	262489199 - PRIMARY HEALTHCARE LLC	NJ	Internal Medicine Physician (207R00000X)
United	45380	$270.68	1659383651 - GEETA GUPTA	223546296 - AVINASH C. GUPTA, M.D., P.C.	NJ	Internal Medicine Physician (207R00000X)
United	45380	$357.79	1982600169 - KARL CHEN	464396447 - KARL T CHEN LLC	NJ	Internal Medicine Physician (207R00000X)
United	45380	$135.18	1679815922 - BETH SOSIN	30438763 - SOUTH ORANGE OB/GYN & INFERTILITY GROUP	NJ	Obstetrics & Gynecology Physician (207V00000X)
United	45380	$880.88	1811230626 - HEEPEEL CHANG	264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C	NY	Vascular Surgery Physician (2086S0129X)
United	45380	$128.40	1063492965 - DAYA NADARAJAH	223720489 - PULMONARY MEDICAL ASSOCIATES L	NJ	Internal Medicine Physician (207R00000X)
United	45380	$803.51	1376510594 - RALPH RUSSO	271348772 - VIRTUA MEDICAL GROUP PA	NJ	Cardiovascular Disease Physician (207RC0000X)
United	45380	$169.21	1366609174 - MARIA CAMPOALEGRE	461230876 - DR MARIA A CAMPOALEGRE MDPA	NJ	Internal Medicine Physician (207R00000X)
United	45380	$211.67	1194012856 - LATOYA ROBERTS	223504924 - MED-COM HEALTH SERVICES, P A	NJ	Internal Medicine Physician (207R00000X)
United	45380	$652.81	1295066637 - RAJAT NOG	264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C	NY	Infectious Disease Physician (207RI0200X)
United	45380	$1066.98	1144419094 - PUNEET KAUR	453023019 - NORTH SHORE-LIJ MEDICAL PC	NY	Medical Physician Assistant (363AM0700X)
United	45380	$353.92	1295831782 - ARIF NASEEM	223482637 - JFK MEDICAL GROUP PC	NJ	Internal Medicine Physician (207R00000X)
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 45380 vs. Other Surgical Procedures on the Colon and Rectum Codes

The CPT 45380 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 45380 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
45338-CPT	Moderate	Colonoscopy To Remove Tissue, An Exam Of The Lower Part Of The Large Intestine (Colon) Using A Scope (Sigmoidoscopy). The Procedure Removes Abnormal Tissue Growths Such As Tumors Or Polyps.
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
45379-CPT	Moderate	Colonoscopy Flexible Proxima, Colonoscopy Flexible Proximal To Splenic Flexure Withremoval Of Foreign Body Colonoscopy Flexible Proximal To Splenic Flexure With
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).

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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