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: September 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	Surgery Surgical Procedures on the Digestive System
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
Medicaid Fee Schedule	View Medicaid rates for 45380

National average reimbursement for CPT 45380 by major payers:

$555.65

$584.56

$651.25

$375.07

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
NYHospitalist PhysicianNPI 1164919551Tax ID 13-5562308
$2,187.69Published rate
Rajat Nog
Westchester Medical Center Advanced Physician Services, P.C
NYInfectious Disease PhysicianNPI 1295066637Tax ID 26-4709927
$652.81Published rate
Gary Gorodokin
Gastroenterology Consultants Of North Jersey, P.C.
NJGastroenterology PhysicianNPI 1619996774Tax ID 22-3578721
$381.22Published rate
Suzanne Palinski
Henry J Austin Health Center Inc
NYPediatrics PhysicianNPI 1124041538Tax ID 22-2682708
$270.68Published rate
Kalpana Kumari
Rise Shine Pediatrics PC
NJPediatrics PhysicianNPI 1477703239Tax ID 46-0877613
$123.69Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

Explore state-level rates by specialty

CPT 45380 vs. Other Surgical Procedures on the Digestive System Codes

The CPT 45380 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 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
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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CPT 45380 Fee Schedule

Compare published rates across providers.

Omar Moussa

Rajat Nog

Gary Gorodokin

Suzanne Palinski

Kalpana Kumari