CPT 45384: Flexible Colonoscopy with Removal Using Hot Biopsy Forceps
Medicare pays $559 and commercial payers pay $802 on average nationally for this procedure.
CPT code 45384 describes a flexible colonoscopy procedure in which a colonoscope is used to examine the rectum and colon and remove one or more tumors, polyps, or other lesions using hot biopsy forceps; service type: endoscopic therapeutic polypectomy/lesion removal; typical site of service: outpatient endoscopy suite or ambulatory surgery 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), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.
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National Reimbursement Benchmarks
Across national payers, Medicare’s mean of $558.8 sits below BUCA’s average commercial mean of $802.4, indicating that BUCA reimbursements are roughly $243.6 higher on average than Medicare for CPT 45384. This gap highlights a material difference between a federal program’s payment level and a representative commercial payer’s average, with Medicare’s 47 localities summarizing a tighter centralized schedule versus BUCA’s broader commercial positioning.
Dispersion measured as P75 minus P25 shows variability is widest for Blue Cross Blue Shield (BCBS) with a range of $822.0 ($1,405.6 − $568.7), followed by UnitedHealth Group at $549.6 ($871.1 − $417.5). The tightest spreads are Aetna at $366.9 ($455.1 − $84.2) and Cigna at $407.2 ($743.8 − $343.6). BUCA’s interquartile range is $642.0 ($1,098.9 − $445.7), and Medicare’s IQR is $62.0 ($582 − $520), illustrating much narrower local variation for Medicare versus most commercial payers.