CPT 45380: Flexible Colonoscopy with Biopsy
Medicare pays $498 and commercial payers pay $769 on average nationally for this procedure.
CPT code 45380 describes a flexible diagnostic colonoscopy with biopsy, a procedure in which a provider uses a flexible colonoscope with a light and camera to examine the rectum and colon for causes of symptoms such as diarrhea, constipation, rectal bleeding, or abdominal pain, and removes one or more suspicious tissue samples for submission to pathology; Service type: diagnostic endoscopic procedure with biopsy; Typical site of service: endoscopy suite or outpatient hospital/ambulatory surgical center.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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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.