Colonoscopy w/lesion removal

What is CPT Code 45385?

Colonoscopy with polypectomy — removal of one or more polyps by snare technique during a colonoscopy. Billed when polyps are removed to prevent colorectal cancer progression.

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 45385

• !Multiple polypectomy units billed when only one polyp was removed
• !45385 billed alongside 45378 or 45380 — the polypectomy code includes the colonoscopy
• !Snare polypectomy and biopsy both billed for the same polyp

Red Flags on Your Bill

Negotiation Tips for CPT 45385

1. 1If you had a screening colonoscopy that found polyps, the entire procedure may still be covered as preventive under ACA rules — verify with your insurer
2. 2The pathology bill for the removed polyps will arrive separately — ask the gastroenterologist which lab they use and whether it is in-network
3. 3ASC vs hospital facility fee difference for polypectomy colonoscopy can be $1,000–$2,000

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 45385 on Your Bill?

If you see CPT code 45385 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 45385 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 45385 billed at [amount]. The Medicare rate for this procedure is $456.45. I'd like to discuss a fair adjustment.”