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See a sample rate comparisonCPT 45390 Fee Schedule
Medicare rates as of October 2026
CPT 45390 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Endoscopic Mucosal Resection
| 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 | 59 - Distinct Procedural Service PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $290.25 national non-facility rate (2026) · View Medicare rates for 45390 |
| Medicaid Fee Schedule | $232.785 median of the 8 states in the free preview · View Medicaid rates for 45390 |
National average reimbursement for CPT 45390 by major payers:
$469.68
BCBS / Anthem
$466.67
UnitedHealthcare
$518.95
Aetna
$569.18
Cigna
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CPT 45390
5 of 25 sample ratesHigher to lower in this preview
Hamilton Surgery Center L.L.C., Surger Center At Hamilton
Hamilton Surgery Center, LLC
$1,910.00Published rateMentor Surgery Center Ltd
Mentor Surgery Center,Ltd
$959.00Published rateAdvanced Gastroenterology
$780.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$565.00Published rateGastrointestinal Center Of Hialeah, LLC
Gastrointestinal Center Of Hialeah LLC
$380.00Published rate
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See a sample payer proposalCPT 45390 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 45390. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 45349-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Endoscopic Mucosal Resection. |
| 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. |
| 45390-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Endoscopic Mucosal Resection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45390. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45390 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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Frequently Asked Questions
CPT 45390 reports a flexible colonoscopy with endoscopic mucosal resection (EMR), a technique for removing larger flat lesions by lifting them with an injection and resecting them.
Biopsy (45380), submucosal injection (45381) and snare removal (45385) of the same lesion are not reported separately with 45390. Work on separate lesions can be. CPT 45390 has a 0-day global period.
Medicare pays CPT 45390 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 45390 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.