Colonoscopy and biopsy

What is CPT Code 45380?

Colonoscopy with biopsy — a full colonoscopy with one or more tissue biopsies taken during the procedure. Used when suspicious lesions, polyps, or areas of concern are seen that need pathologic evaluation.

The Medicare reimbursement rate shown above is the amount the federal government has determined is a reasonable payment for this service. Hospitals and providers that participate in Medicare have agreed to accept these rates from Medicare patients.

Who typically bills this:Gastroenterologist + facility (ASC or hospital) + separate pathologist

Common Billing Errors for CPT 45380

• !Billed alongside 45378 (diagnostic colonoscopy) — 45380 already includes the colonoscopy
• !Separate polypectomy code 45385 also billed when only biopsies were taken
• !Pathology charges arrive separately from the lab that processed the biopsy specimens

Red Flags on Your Bill

Negotiation Tips for CPT 45380

1. 145380 includes the colonoscopy — 45378 should not also appear on the same claim
2. 2Pathology from biopsies will arrive as a separate bill from a pathologist or reference lab — plan for an additional $50–$200
3. 3Ask whether the facility where your colonoscopy was done is in-network before scheduling

Codes That Often Appear With This One

These CPT codes commonly appear on the same bill. Review each one to spot potential bundling errors or duplicate charges.

Found CPT 45380 on Your Bill?

If you see CPT code 45380 on a hospital or medical bill, compare the charged amount to the Medicare rate above. If your bill shows a significantly higher charge, you may have grounds to negotiate.

1. Note the amount charged for CPT 45380 on your itemized bill
2. Compare it to the Medicare rate above — calculate the markup
3. Call the billing department and use the Medicare rate as your anchor:“I see CPT code 45380 billed at [amount]. The Medicare rate for this procedure is $436.47. I'd like to discuss a fair adjustment.”