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See a sample rate comparisonCPT 45381 Fee Schedule
Medicare rates as of October 2026
CPT 45381 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Intestinal Exam (Colonoscopy), An Exam Of The Intestine Using A Scope (Colonoscopy). An Injection Is Given Into The Intestinal Tissues During The Exam.
| 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 PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $490.33 national non-facility rate (2026) · View Medicare rates for 45381 |
| Medicaid Fee Schedule | $385.05 median of the 8 states in the free preview · View Medicaid rates for 45381 |
National average reimbursement for CPT 45381 by major payers:
$553.63
BCBS / Anthem
$576.87
UnitedHealthcare
$640.50
Aetna
$362.40
Cigna
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CPT 45381
5 of 25 sample ratesHigher to lower in this preview
Jessica Wachtel
$905.17Published ratePaul Foster
Medical Associates Of Englewood PC
$725.20Published rateYingzi Deng
$442.73Published rateDiptika Patel
$322.85Published rateNoel Ilogu
Noel Ilogu, Md
$122.27Published rate
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See a sample payer proposalCPT 45381 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45381. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 45335-CPT | Moderate | Exam Left Colon With Scope, Exam Of The Left Side Of The Lower Colon Using A Flexible Scope Inserted Into The Rectum (Sigmoidoscopy). The Procedure Includes An Injection. |
| 45381-CPT | Moderate | Intestinal Exam (Colonoscopy), An Exam Of The Intestine Using A Scope (Colonoscopy). An Injection Is Given Into The Intestinal Tissues During The Exam. |
| 45385-CPT | Moderate | Colonoscopy To Remove Growth, An Exam Of The Intestine Using A Scope (Colonoscopy). The Procedure Includes Removing One Or More Tissue Growths Such As A Tumor Or Polyp. |
| 45390-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Endoscopic Mucosal Resection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45381 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 stands for Current Procedural Terminology. It is a standardized set of five-digit codes used by healthcare providers, payers, and facilities to describe medical, surgical, and diagnostic services. These codes are crucial for billing and reimbursement processes, ensuring a consistent understanding of the services rendered across the healthcare system.
Finding the exact cost of a medical procedure can be complex due to various factors like your insurance plan, location, and specific provider. You can start by contacting your healthcare provider's billing department for an estimate. For more generalized information or to search for specific CPT code pricing based on your location, you can utilize resources like Payerprice. They offer a fee schedule lookup tool that allows you to search with CPT codes and specific locations to get a better understanding of potential costs.
Healthcare prices can vary significantly due to multiple factors, including geographical location, the type of facility (e.g., hospital vs. outpatient clinic), the specific provider, negotiated rates with different insurance companies, and the complexity of the service. Each provider and payer may have different fee schedules, leading to a wide range of costs for the same service.
It is unlikely that your insurance will cover the full cost of a procedure without any out-of-pocket expenses. Most insurance plans have deductibles, co-pays, and co-insurance that you are responsible for paying. The extent of coverage also depends on whether the service is considered in-network or out-of-network, and if it's deemed medically necessary. Always contact your insurance provider directly to understand your specific benefits and estimated out-of-pocket costs for any planned procedure.
To get an estimate for a specific medical service in your area, you should first obtain the CPT code for the service from your doctor or healthcare provider. Then, you can use online tools specifically designed for price transparency. Payerprice offers a fee schedule lookup tool where you can enter the CPT code and your specific location to find typical prices for that service in your area. Additionally, always confirm with your healthcare provider's billing department for a personalized estimate that considers your specific situation and insurance plan.