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CPT 45380: Flexible Colonoscopy with Biopsy
CPT code 45380 represents a diagnostic flexible colonoscopy with biopsy, a commonly used endoscopic procedure to visualize the rectum and entire colon and obtain tissue samples for histopathologic analysis. The code matters nationally because colonoscopy with biopsy is a key tool for diagnosing infectious, inflammatory, and neoplastic diseases of the colon and rectum and drives significant outpatient procedural volume and pathology utilization across payers.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, its typical sites of service, commonly associated clinical indications, and related procedure coding considerations. The content highlights how 45380 fits into procedural families for colonoscopy and notes related codes for lesion removal techniques.
The publication is intended for billing managers, specialty clinicians, and policy analysts seeking a clear clinical and coding summary: what the code represents, where it is typically performed, and which payers commonly reimburse the service. Data not available in the input is noted where applicable. The piece does not provide clinical recommendations but supplies a focused, practical reference for coding and administrative decision-making.
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Billing Code Overview
CPT code 45380 describes a diagnostic flexible colonoscopy with biopsy. The procedure uses a flexible colonoscope with a light source and camera to examine the rectum and colon to evaluate symptoms such as diarrhea, constipation, rectal bleeding, or abdominal pain. During the examination the provider excises one or more suspicious areas of tissue using biopsy forceps and submits the specimens for laboratory analysis.
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Service type: Diagnostic endoscopic procedure with biopsy
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in endoscopy suites or outpatient clinics equipped for colonoscopy
National Reimbursement Benchmarks
Medicare's mean rate sits at $498.10, which is modestly below the BUCA average commercial mean of $769.40, indicating that commercial arrangements captured by BUCA tend to pay substantially more than Medicare on average for CPT 45380. That gap of $271.30 reflects a meaningful premium in commercial pricing versus the government benchmark, with BUCA representing higher mean commercial reimbursements.
Dispersion (P75−P25) varies notably across payers. Blue Cross Blue Shield shows the widest interquartile spread at $793.00 ($1,348.50−$553.70), followed by UnitedHealth Group at $418.00 ($799.90−$378.10) and BUCA at $625.00 ($1,047.00−$422.90). Aetna and Cigna are comparatively tighter with spreads of $384.10 ($460.80−$61.50) and $372.00 ($674.60−$302.70), respectively, indicating more concentrated commercial outcomes for those payers.