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 |
| Medicare Fee Schedule | View Medicare rates for 45386 |
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 | $917.57 | 1679652119 - CHARLES BIGAJER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $907.20 | 1770552945 - ADNAN BADR | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $796.46 | 1528354545 - OBINNA UKABAM | 752646477 - (TX) UMC PHYSICIANS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1080.70 | 1114152048 - MELVIN SIMIEN | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $801.09 | 1790845840 - BETHANY DEVITO | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $2016.91 | 1619348430 - AHMED DIRWEESH | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | NJ | Gastroenterology Physician (207RG0100X) |
United | 45386 | $928.15 | 1093908113 - AMAN ALI | 300976099 | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $654.15 | 1356510515 - CONWAY HUANG | 453508803 - (TX) LHP TEXAS MD SERVICES INC | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1534.90 | 1538301270 - PETER STEIN | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $713.54 | 1356428387 - NEW YORK GASTROENTEROLOGY ASSOCIATES LLP | 134056764 - (NY) NEW YORK GASTROENTEROLOGY ASSOCIATES, LLP | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $840.00 | 1639155005 - DAVID SPADY | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $840.00 | 1659458032 - MOHAMMAD TAHERI | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 45386 | $1046.68 | 1568859031 - MONICA PASSI | 540892627 - (VA) GASTROENTEROLOGY ASSOC. OF N. VA | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $363.73 | 1417941618 - CHERIF EL YOUNIS | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | Gastroenterology Physician (207RG0100X) |
United | 45386 | $548.97 | 1316923253 - PETER BLOOM | 161569074 - (NY) GASTROENTEROLOGY ASSOCIATES, LLP | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 45386) and we'll show you how you compare in 15 minutes or less.