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See a sample rate comparisonCPT 45386 Fee Schedule
Last Verified: October 2026
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.
Enlarge Interior Of Intestines, An Exam Of The Lower Part Of The Intestine (Colon) Using A Scope (Colonoscopy). The Procedure Includes Stretching Or Enlarging The Interior Where The Intestine Has Become Too Narrow (Stricture).
| 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 PT - Colorectal cancer screening test; converted to diagnostic test or other procedure 33 - Preventive Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45386 |
| Medicaid Fee Schedule | View Medicaid rates for 45386 |
National average reimbursement for CPT 45386 by major payers:
$782.37
$837.52
$911.82
$402.63
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CPT 45386
5 of 25 sample ratesHigher to lower in this preview
Ahmed Dirweesh
University Of Minnesota Health Clinics And Surgery Center Inc
$2,016.91Published rateMonica Passi
Gastroenterology Assoc. Of N. Va
$1,046.68Published rateMohammad Taheri
Texas Digestive Disease Consultants
$840.00Published rateAlexander Brodsky
Gastroenterology Associates Of Brooklyn
$620.34Published rateCherif El Younis
Brookdale Hospital Medical Center
$363.73Published rate
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See a sample payer proposalCPT 45386 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45386 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 45386 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 |
|---|---|---|
| 45340-CPT | Moderate | Exam Of Narrowed Intestine, An Exam Of The Large Intestine Using A Scope (Sigmoidoscopy). The Procedure Enlarges A Section That Has Become Narrowed. |
| 45347-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed With Placement Of Endoscopic Stent Includes Pre And Post-Dilat |
| 45386-CPT | Moderate | Enlarge Interior Of Intestines, An Exam Of The Lower Part Of The Intestine (Colon) Using A Scope (Colonoscopy). The Procedure Includes Stretching Or Enlarging The Interior Where The Intestine Has Become Too Narrow (Stricture). |
| 45392-CPT | Moderate | Colonoscopy W Endoscopic Fnb, Colonoscopy Flexible With Transendoscopic Ultrasound Guided Intramural Or Transmural Fine Needle Aspiration Biopsy S Includes Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45386. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45386 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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