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 | Endoscopy Procedures on the Rectum Surgical Procedures on the Colon and Rectum |
| 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 |
| Medicare Fee Schedule | View Medicare rates for 45385 |
National average reimbursement for CPT 45385 by major payers:
$594.16
$631.96
$696.85
$459.40
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 45385 | $462.54 | 1407115041 - CECILE BESINGI | 811200310 - CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Pediatrics Physician (208000000X) |
United | 45385 | $827.82 | 1548601594 - MAGNA PASTRANO LLUBERES | 141981653 - HACKENSACK MERIDIAN HEALTH MEDICAL GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 45385 | $420.23 | 1396846705 - SANG K. HAN, M.D., F.A.C.S., P.A. | 521161451 - (MD) SANG K HAN MD FACS PA | MD | Surgery Physician (208600000X) |
United | 45385 | $511.08 | 1255351516 - GENERAL SURGERY SPECIALISTS LLC, DRS GANN SCHULTZ AND GERTNER PA | 203828875 - (MD) GENERAL SURGERY SPECIALISTS LLC | MD | Surgery Physician (208600000X) |
United | 45385 | $777.14 | 1205129533 - MICHAEL GALABI | 202088165 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 45385 | $902.64 | 1518907773 - RENUKA VERMA | 223357053 - MONMOUTH MEDICAL CENTER FACULTY PRACTICE PLAN INC | NJ | Pediatrics Physician (208000000X) |
United | 45385 | $1112.02 | 1063891265 - ALENA NAUMOVA | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 45385 | $655.15 | 1689818767 - TAO XU | 611661781 | NY | Internal Medicine Physician (207R00000X) |
United | 45385 | $785.97 | 1174677751 - GAETANO BELLO | 800756169 | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 45385 | $750.00 | 1750434759 - TOWER OAKS SURGERY CENTER, LLC | 204877029 - (MD) TOWER OAKS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45385 | $1701.68 | 1992021844 - HAMZA AZIZ | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Surgery Physician (208600000X) |
United | 45385 | $675.25 | 1154814135 - GABRIELA ROSS | 943283324 - LIFELINE MEDICAL ASSOCIATES, LLC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 45385 | $628.98 | 1427518513 - ATUL SINHA | 113465690 | NY | Internal Medicine Physician (207R00000X) |
United | 45385 | $978.64 | 1215941091 - MICHAEL ROSENBAND | 112924518 | NY | Interventional Cardiology Physician (207RI0011X) |
United | 45385 | $584.00 | 1255347050 - MARYLAND EYE SURGERY CENTER, L.L.C., THE SURGERY CENTER | 522205280 - (MD) MARYLAND EYE SURGERY CENTER LLC | 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 Colon and Rectum Codes
The CPT 45385 code is part of the Endoscopy Procedures on the Rectum services used for Surgical Procedures on the Colon and Rectum. 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 Decompress, Sigmoidoscopy Flexible With Decompression For Pathologic Distention Eg Volvulus Megacolon Including Placement Of Decompression Tube When Performed |
| 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. |
| 45350-CPT | Moderate | Treatment For Hemorrhoid, Procedure On The Intestine With A Scope (Sigmoidoscopy). It Includes Applying A Small Band To The Base Of The Hemorrhoid Which Stops The Flow Of Blood. |
| 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. |
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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