| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $338.76 |
| Typical Billed Amount What providers commonly charge | $700 – $4500 |
| Potential Markup How much more you might pay vs. Medicare rate | 1228% above Medicare |
What CPT 45385 Means and When It's Used
CPT code 45385 represents a colonoscopy with polypectomy by snare technique. During this procedure, your gastroenterologist uses a flexible tube with a camera (colonoscope) to examine your entire colon and removes any polyps they find using a wire loop tool called a snare.
Your doctor will use this code when they discover and remove polyps during your colonoscopy. The snare technique is the most common method for removing larger polyps (typically over 5mm). If polyps are found and removed, your procedure changes from a routine screening colonoscopy to a therapeutic procedure, which affects both the billing code used and your potential out-of-pocket costs.
This procedure is considered both diagnostic (examining your colon) and therapeutic (removing polyps), which is why it's billed differently than a colonoscopy where no polyps are found or removed.
Understanding the Costs and What to Expect on Your Bill
The cost for CPT code 45385 varies significantly depending on your location, healthcare provider, and insurance coverage. Medicare reimburses this procedure at $338.76, but typical charges from healthcare facilities range from $700 to $4500. The wide range reflects differences in facility fees, geographic location, and whether the procedure is performed in a hospital outpatient department versus an ambulatory surgery center.
On your bill or explanation of benefits, you'll see CPT code 45385 listed along with the charge amount. You may also see additional codes for anesthesia, facility fees, or pathology services if the removed polyps are sent to a lab for testing. If you have insurance, your out-of-pocket cost will depend on whether you've met your deductible and your plan's coinsurance requirements.
It's important to note that this code has a high error rate in medical billing, meaning it's frequently billed incorrectly. Common mistakes include confusion with similar codes like 45380 (colonoscopy with biopsy) or 45378 (diagnostic colonoscopy without polyp removal).
How to Verify Your Bill and What to Do If Something Seems Wrong
To check if you were billed correctly, first confirm that polyps were actually removed during your procedure by reviewing your procedure notes or asking your doctor's office. If no polyps were removed, you should see CPT code 45378 instead. If polyps were biopsied but not completely removed, the correct code would be 45380.
Compare the charges on your bill to the typical range of $700-$4500. If your charge seems unusually high, contact your healthcare provider's billing department to request an itemized bill and explanation of charges. Ask specifically about facility fees, which can significantly increase the total cost.
If you believe there's an error, start by calling your healthcare provider's billing department with your specific concerns. Document all conversations and keep records of your communications. If the provider doesn't resolve the issue, contact your insurance company to report the potential billing error. You can also file a complaint with your state's insurance commissioner if necessary. Remember that you have the right to understand and question any medical bills you receive.