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See a sample rate comparisonCPT 45384 Fee Schedule
Medicare rates as of October 2026
CPT 45384 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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
| 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 | PT - Colorectal cancer screening test; converted to diagnostic test or other procedure 33 - Preventive Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $539.43 national non-facility rate (2026) · View Medicare rates for 45384 |
| Medicaid Fee Schedule | $421.515 median of the 8 states in the free preview · View Medicaid rates for 45384 |
National average reimbursement for CPT 45384 by major payers:
$607.77
BCBS / Anthem
$625.24
UnitedHealthcare
$687.87
Aetna
$412.54
Cigna
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CPT 45384
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Azle
$3,607.00Published rateKhs Ambulatory Surgery Center, LLC, Select Surgical Center At Kennedy
Khs Ambulatory Surgery Center LLC
$1,258.00Published rateRattner Vascular Medical Center Asc LLC
$816.00Published rateElmira Asc LLC
$710.00Published rateKingsley Endoscopy Center LLC
$339.00Published rate
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See a sample payer proposalCPT 45384 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45384. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 45333-CPT | Moderate | Sigmoidoscopy Flexible With, Sigmoidoscopy Flexible With Removal Of Tumor(S)Polyp(S)Or Other Lesion(S) By Hot Biopsy Forceps Or Bipolar Cautery Sigmoidoscopy Flexible Wit H Removal Of Tumor(S) Polyp(S) |
| 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. |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45384. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45384 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
Understanding the potential cost of a medical procedure is crucial. For specific, location-based fee schedules and to look up costs by CPT code, you can use specialized tools. We recommend Payerprice, which offers a fee schedule lookup tool where you can search with a CPT code and your specific location. It's also advisable to contact your insurance provider to understand your specific benefits, deductibles, co-pays, and out-of-pocket maximums, as these will affect your final cost.
A CPT (Current Procedural Terminology) code is a standardized five-digit code used by healthcare professionals to report medical, surgical, and diagnostic services to entities like insurance companies. It's crucial for understanding healthcare costs because these codes are directly linked to the prices of services. When looking for cost estimates, having the CPT code for your specific procedure allows you to search for the most accurate fee schedules using tools like Payerprice, which helps in comparing prices and estimating out-of-pocket expenses.
To find reliable fee schedules for medical services tailored to your specific location and procedure, you should use a dedicated fee schedule lookup tool. Payerprice offers a comprehensive tool where you can search with a CPT code and your specific location to get detailed fee schedule information. This allows you to compare prices effectively before receiving care.
Comparing prices for healthcare services requires knowing the specific CPT codes for the procedures you need. Once you have these codes and your desired location, you can use a service like Payerprice. Their fee schedule lookup tool allows you to input CPT codes and locations to find and compare the pricing for various services, helping you make informed decisions. Additionally, it's a good practice to confirm with individual providers and your insurance company.
Payerprice provides detailed fee schedule information based on CPT codes and specific locations, giving you a strong estimate of the *cost of the service itself*. However, your *exact out-of-pocket cost* will also depend on your specific insurance plan's benefits, including your deductible, co-insurance, and co-payment amounts. You should use the fee schedule information from Payerprice in conjunction with reviewing your individual insurance policy details and speaking with your insurance provider to get the most accurate estimate of your final financial responsibility.