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See a sample rate comparisonCPT 45391 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.
Colonoscopy W Endoscope Us, Colonoscopy Flexible With Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 51 - Multiple procedures 33 - Preventive Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45391 |
| Medicaid Fee Schedule | View Medicaid rates for 45391 |
National average reimbursement for CPT 45391 by major payers:
$360.50
$366.17
$390.68
$444.35
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CPT 45391
5 of 25 sample ratesHigher to lower in this preview
Reston Surgery Center, Lp
Reston Surgery Center Lp
$2,925.00Published rateMedstar Surgery Center At Brandywine, LLC
Medstar Surgery Center At Bran
$1,316.00Published rateSansum Clinic, Foothill Surgery Center At Sansum Clinic
Sansum Clinic
$1,105.00Published rateTidalhealth Surgery Center, LLC
$614.00Published rateZion Ambulatory Center LLC
$396.00Published rate
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See a sample payer proposalCPT 45391 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45391 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 45391 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 | 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. |
| 45341-CPT | Low | Sigmoidoscopy Flexible Diagn, Sigmoidoscopy Flexible Diagnostic With Or Woutcollection Of Specimen(S) By Brushing Or Washing (Separate Procedure) With Endoscopic Ultrasound Examination. |
| 45391-CPT | Moderate | Colonoscopy W Endoscope Us, Colonoscopy Flexible With Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures |
| 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 45391. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45391 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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