CPT 45386 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 • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure • 33 - Preventive Services |
| Complexity Level | Moderate |
| CMS | $574.15 Physician Fee Schedule |
National average reimbursement for CPT 45386 by major payers:
$782.37
$837.52
$911.82
$998.95
| 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 45386 | ||||||
United | 45386 | $912.03 | 1447347075 - ERIC TEITEL | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | AZ | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1166.00 | 1831519495 - FIRAS AL-ANI | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $580.32 | 1235536913 - DALIA MAHMOUD HASSAN ELAMIN | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $840.00 | 1417290297 - BRANDON SZETO | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $597.11 | 1477716041 - DAVID BEYDA | 473639318 | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $622.28 | 1134212558 - ASADUR MIAH | 260086016 - ASADUR MIAH PHYSICIANS P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $924.00 | 1417933599 - WILLIAM HODGES | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $415.35 | 1932121456 - GEORGE SURLA | 200049072 - (NY) GREATER NEW YORK GASTROENTEROLOGY, LLP | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $600.46 | 1265417299 - JAN SHIM | 134167173 | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $432.85 | 1477716041 - DAVID BEYDA | 465399519 | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1201.61 | 1265747489 - KASIM KAZBAY | 611661781 | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $363.73 | 1417941618 - CHERIF EL YOUNIS | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $917.57 | 1679652119 - CHARLES BIGAJER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $376.98 | 1093235103 - JUDAH HOROWITZ | 463729058 - (NY) GASTROENTEROLOGY ASSOCIATES OF BROOKLYN | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1526.59 | 1073870358 - ANAND SHAH | 273818647 | NY | Gastroenterology Physician (207RG0100X) |
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 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 |
|---|---|---|
| 45338-CPT | Moderate | Sigmoidoscopy, Flexible; With Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique |
| 45340-CPT | Moderate | Sigmoidoscopy, Flexible; With Dilation By Balloon, 1 Or More Strictures |
| 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 | Colonoscopy Flexible With Transendoscopic Balloon Dilation (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 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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