CPT 45385: Colonoscopy with Snare Polypectomy
Medicare pays $518 and commercial payers pay $827 on average nationally for this procedure.
CPT code 45385 describes a colonoscopy procedure using a colonoscope to examine the colon and rectum with removal of one or more tumors, polyps, or other lesions using a snare (endoscopic polypectomy). Service type: endoscopic therapeutic procedure; 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), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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National Reimbursement Benchmarks
Medicare's mean allowed amount of $517.70 sits between lower and higher commercial averages, while BUCA's average commercial mean of $826.50 is substantially higher than Medicare, creating a gap of $308.80. This difference highlights a common commercial-to-Medicare divergence for CPT 45385, with BUCA aligning closer to the upper commercial tier represented by payers like Blue Cross Blue Shield and UnitedHealth Group.
Dispersion measured as P75 minus P25 varies notably: Blue Cross Blue Shield shows the widest interquartile spread at $825.90 (P75 $1,408.40 minus P25 $582.50), followed by UnitedHealth Group at $457.30 and Cigna at $432.30. Aetna's spread is $311.40 and BUCA's spread is $640.00, making Blue Cross Blue Shield the most variable and Aetna the tightest among these payers.