CPT 45389 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 | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 52 - Reduced Services 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45389 |
National average reimbursement for CPT 45389 by major payers:
$395.27
$416.67
$427.01
$494.54
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 45389 | $525.00 | 1396812491 - VALLEY ENDOSCOPY CENTER, INC | 611435080 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $789.00 | 1992702443 - THE EASTSIDE ENDOSCOPY CENTER LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1849.00 | 1578566758 - ADVANCED AMBULATORY SURGICAL CARE, LP, ADVANCED SURGICAL CARE | 203833272 - (MO) ADVANCED AMBULATORY SURGICAL CARE LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $350.00 | 1376748228 - FLORIDA SPECIALTY SURGERY CENTER LLC | 203672687 - (FL) FLORIDA SPECIALTY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1258.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1179.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $780.00 | 1033271176 - HALLMARK SURGICAL CENTER OF NORTHRIDGE | 954683164 - (CA) NORTHRIDGE SURGERY AND PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1233.00 | 1851950281 - YUMA ADVANCED SURGICAL SUITES LLC | 833076801 - (AZ) YUMA ADVANCED SURGICAL SUITES, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $606.00 | 1225378276 - WHITE OAK SURGERY CENTER | 273885555 - (GA) WHITE OAK SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $2670.00 | 1780853044 - HACIENDA SURGERY CENTER, LLC | 320439356 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1275.00 | 1346773421 - WOMEN'S CARE FLORIDA LLC, WOMEN'S CARE FLORIDA SURGICAL CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1250.00 | 1821036534 - PARKWAY SURGERY CENTER, LLC | 204127100 - (MD) PARKWAY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1666.00 | 1831275775 - NORTH JERSEY GASTROENTEROLOGY & ENDOSCOPY CENTER P.A. | 223637494 - (NJ) NORTH JERSEY GASTROENTEROLOGY ENDOSCOPY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1179.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45389 | $1508.00 | 1114260254 - SPRING HILL SURGERY CENTER, LLC | 462325870 - (TN) SPRING HILL SURGERY CENTER LLC | TN | 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 45389 vs. Other Surgical Procedures on the Colon and Rectum Codes
The CPT 45389 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 45389 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 |
|---|---|---|
| 45327-CPT | Low | Large Intestine Scope Exam, Exam Of The Large Intestine (Colon) Using A Scope (Sigmoidoscopy). The Procedure Implants A Support Device (Stent). |
| 45342-CPT | Moderate | Biopsy Of Large Intestine, An Exam Of The Lower Portion Of The Large Intestine Using A Scope (Sigmoidoscopy). The Procedure May Use Ultrasound (Sound Wave Images) To Guide Removal Of A Sample Of Tissue For Testing (Biopsy). |
| 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. |
| 45389-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed, With Endoscopic Stent Placement Includes Pre And Post Dilation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45389. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45389 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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