CPT 45384: Colonoscopy with Lesion Removal Using Hot Biopsy Forceps
CPT code 45384 denotes a flexible colonoscopy in which the provider removes one or more tumors, polyps, or other lesions using hot biopsy forceps. This code captures a combined diagnostic and therapeutic endoscopic encounter targeting the rectum and colon. Nationally, procedures represented by this code are a key component of colorectal disease management, including treatment of neoplastic and benign mucosal lesions, and have implications for quality reporting, utilization patterns, and procedure-level policy.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, how it differentiates from related colonoscopy codes, and an overview of common billing considerations. The publication provides benchmarks and comparators, notes of relevance for coding and coverage policy, and guidance on how CPT code 45384 fits within a broader set of endoscopic interventions.
This summary is designed for national audiences — including clinicians, revenue managers, and policy analysts — seeking a practical reference on the clinical intent and billing classification of CPT code 45384. Data not available in the input will be identified explicitly in the full document.
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Billing Code Overview
CPT code 45384 describes a diagnostic and therapeutic colonoscopy performed with a flexible colonoscope in which one or more tumors, polyps, or other lesions are removed using hot biopsy forceps. The procedure involves direct visualization of the rectum and colon using a tubular instrument with a light source and camera to both inspect and treat mucosal lesions.
Service Type: Endoscopic therapeutic procedure (colonoscopy with hot biopsy forceps removal of lesion[s])
Typical Site of Service: Ambulatory endoscopy suite, hospital outpatient department, or other outpatient surgical setting where flexible colonoscopy is performed
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.