CPT 45385 Fee Schedule
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.
| 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 • 33 - Preventive Services • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| CMS | $435.38 Physician Fee Schedule |
National average reimbursement for CPT 45385 by major payers:
$594.16
$631.96
$696.85
$762.37
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 45385 | ||||||
United | 45385 | $556.88 | 1790306264 - JAIMIE RAVIT | 611661781 | NY | Registered Dietitian (133V00000X) |
United | 45385 | $768.25 | 1285022483 - NABRAS AHMED | 161012691 - CANTON-POTSDAM HOSPITAL | NY | Gastroenterology Physician (207RG0100X) |
United | 45385 | $462.54 | 1407115041 - CECILE BESINGI | 811200310 - CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Pediatrics Physician (208000000X) |
United | 45385 | $372.05 | 1871675785 - JOHN PANTAZOPOULOS | 815109895 - JOHN S PANTAZOPOULOS MD PA | NJ | Cardiovascular Disease Physician (207RC0000X) |
United | 45385 | $836.99 | 1568637858 - PETER LAPMAN | 223357053 - MONMOUTH MEDICAL CENTER FACULTY PRACTICE PLAN INC | NJ | Cardiovascular Disease Physician (207RC0000X) |
United | 45385 | $282.28 | 1548229891 - NONATO PINEDA | 460467314 - COMSTI DEPERIO PINEDA AND ASSOCIATES LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 45385 | $461.20 | 1124374079 - UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER, LLC, UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER | 352445106 - UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER | MD | General Acute Care Hospital (282N00000X) |
United | 45385 | $902.64 | 1518907773 - RENUKA VERMA | 223357053 - MONMOUTH MEDICAL CENTER FACULTY PRACTICE PLAN INC | NJ | Pediatrics Physician (208000000X) |
United | 45385 | $642.31 | 1700890605 - NINA PRIVEN | 611661781 | NY | Internal Medicine Physician (207R00000X) |
United | 45385 | $1276.00 | 1396919783 - SURGCENTER OF SOUTHERN MARYLAND, LLC | 261572885 - (MD) SURGCENTER OF SOUTHERN MARYLAND LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45385 | $644.00 | 1912158684 - SURGCENTER OF BEL AIR | 262215322 - (MD) SURGCENTER OF BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45385 | $197.00 | 1619967726 - JOHN P LYDON DPM, BETHESDA AMBULATORY SURGICAL CENTER | 521248448 - (MD) JOHN P LYDON DPM | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45385 | $372.05 | 1295831782 - ARIF NASEEM | 141981653 - HACKENSACK MERIDIAN HEALTH MEDICAL GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 45385 | $655.15 | 1689818767 - TAO XU | 611661781 | NY | Internal Medicine Physician (207R00000X) |
United | 45385 | $1790.00 | 1215000997 - CHILDREN'S NATIONAL AMBULATORY SURGERY CENTER | 530196580 - CHILDRENS HOSPITAL | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 45385 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45385 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 45385 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 |
|---|---|---|
| 45337-CPT | Low | Sigmoidoscopy Flexible; With Decompression Of (For Pathologic Distention)(Eg Volvulus Megacolon) Including Placement Of Decompression Tube When Performed (Desc Revised 01/01/15) |
| 45338-CPT | Moderate | Sigmoidoscopy, Flexible; With Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique |
| 45350-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Band Ligations(S) (Eg, Hemorrhoids). |
| 45385-CPT | Moderate | Colonoscopy Flexible With Removal Of Tumor(S) Polyp(S) Or Other Lesion(S) By Snare Technique (Desc Revised 01/01/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45385. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45385 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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