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See a sample rate comparisonCPT 45385 Fee Schedule
Medicare rates as of October 2026
CPT 45385 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
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.
| 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 | 33 - Preventive Services PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $500.01 national non-facility rate (2026) · View Medicare rates for 45385 |
| Medicaid Fee Schedule | $401.99 median of the 8 states in the free preview · View Medicaid rates for 45385 |
National average reimbursement for CPT 45385 by major payers:
$594.16
BCBS / Anthem
$631.96
UnitedHealthcare
$696.85
Aetna
$459.40
Cigna
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CPT 45385
5 of 25 sample ratesHigher to lower in this preview
Hongyan Zou
$2,806.57Published rateMichael Rosenband
$978.64Published rateGaetano Bello
$785.97Published rateNina Priven
$642.31Published rateSang K. Han, M.D., F.A.C.S., P.A.
Sang K Han Md Facs PA
$420.23Published rate
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See a sample payer proposalCPT 45385 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45385. Select one to see its fee schedule.
| 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. |
| 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 |
| 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 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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Frequently Asked Questions
The cost of a medical procedure can vary significantly based on your insurance plan, location, and the specific healthcare provider. For accurate, specific pricing information tailored to CPT codes and your location, you can utilize tools like Payerprice. It offers a fee schedule lookup tool that allows you to search with a CPT code and specific location to get relevant pricing data.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by medical professionals to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for billing and determine what a provider gets paid for a service, thereby directly influencing the cost associated with your medical care.
Obtaining exact fee schedules can be challenging as they are often proprietary to insurance companies. However, for a user-friendly way to find fee schedules and pricing information for specific CPT codes in your location, Payerprice offers a dedicated lookup tool. This tool can help you research costs for various medical services, aiding in your financial planning for healthcare.
A chargemaster is a comprehensive list of prices for all services, procedures, and supplies that a hospital or healthcare facility offers. It represents the sticker price, or the maximum amount a hospital would charge. What you actually pay, however, is often different due to negotiated rates with insurance companies, your deductible, co-pays, and co-insurance. Few patients actually pay the full chargemaster price.