Summary & Overview
CPT 45385: Colonoscopy with Snare Removal of Tumor, Polyp, or Lesion
CPT code 45385 is a widely utilized billing code for colonoscopy procedures involving the removal of tumors, polyps, or other lesions by snare technique. This code is central to colorectal cancer screening and management, playing a significant role in preventive care and early intervention for gastrointestinal diseases. The procedure is commonly performed in ambulatory offices and outpatient hospital settings, reflecting its accessibility and importance in routine clinical practice.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, provide coverage for services billed under CPT code 45385. Understanding payer policies and reimbursement benchmarks for this code is essential for healthcare organizations, as it impacts both clinical workflow and financial planning.
This publication offers a comprehensive overview of CPT code 45385, including clinical context, payer coverage, and policy updates. Readers will gain insights into typical sites of service, relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to this procedure. The analysis also highlights related CPT codes and their distinctions, supporting informed decision-making in medical billing and compliance. The information presented is designed to support stakeholders in navigating the evolving landscape of endoscopic procedures and reimbursement.
CPT Code Overview
CPT code 45385 represents a colonoscopy procedure using a flexible scope, performed proximal to the splenic flexure, with removal of tumor(s), polyp(s), or other lesion(s) by snare technique. This service is classified under Endoscopy Procedures on the Rectum (Colonoscopy). The procedure is typically conducted in an ambulatory office or outpatient hospital setting, such as POS 11 Office or POS 19 Outpatient Hospital. Colonoscopy with snare removal is a critical intervention for both diagnostic and therapeutic management of colorectal conditions, enabling physicians to address abnormal growths during the same procedure.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting for a screening or diagnostic colonoscopy due to a history of colon polyps, abnormal fecal findings, or gastrointestinal symptoms. During the procedure, the physician identifies one or more polyps or lesions in the colon proximal to the splenic flexure. Using a flexible colonoscope and a snare technique, the physician removes the identified polyp(s) or lesion(s). The procedure is commonly performed in an ambulatory office or outpatient hospital setting by a gastroenterologist, family medicine physician, internal medicine physician, or colon & rectal surgeon.
Coding Specifications
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Modifier
59: Used to indicate a distinct procedural service when45385is performed in conjunction with45380on a separate lesion or during a separate encounter. -
Modifier
51: Used to indicate multiple procedures when45385is billed along with45384using a different technique.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207RG0100X | Gastroenterology Physician |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
208600000X | Colon & Rectal Surgery Physician |
Related Diagnoses
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K63.5: Polyp of colon- Indicates the presence of colon polyps, which are commonly removed during colonoscopy procedures such as
45385.
- Indicates the presence of colon polyps, which are commonly removed during colonoscopy procedures such as
-
D12.6: Benign neoplasm of colon, unspecified- Represents benign tumors in the colon, which may be removed using snare technique during colonoscopy.
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Z12.11: Encounter for screening for malignant neoplasm of colon- Used for patients undergoing colonoscopy as a screening for colon cancer, often leading to polyp or lesion removal if found.
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K52.9: Noninfective gastroenteritis and colitis, unspecified- Indicates noninfective inflammation of the colon, which may prompt diagnostic colonoscopy and potential removal of abnormal lesions.
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R19.5: Other fecal abnormalities- Used when abnormal fecal findings are present, leading to colonoscopy for further investigation and possible polyp removal.
Related CPT Codes
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45380: Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple- Used when a biopsy is performed during colonoscopy, rather than removal by snare technique. May be performed on separate lesions in the same session as
45385.
- Used when a biopsy is performed during colonoscopy, rather than removal by snare technique. May be performed on separate lesions in the same session as
-
45384: Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps- Used when removal is performed by hot biopsy forceps instead of snare technique. Can be billed with
45385if different techniques are used on separate lesions.
- Used when removal is performed by hot biopsy forceps instead of snare technique. Can be billed with
These codes are commonly used together when multiple lesions are treated using different techniques during the same colonoscopy session.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 45385 under Medicare is $517.72, while the average commercial mean rate (BUCA) is slightly higher at $522.52. Among individual commercial payers, UnitedHealth Group has the highest mean rate at $696.64, and Aetna has the lowest at $437.93.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $55.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group exhibits the widest range at $376.33, reflecting greater variability in commercial rates. Cigna and Blue Cross Blue Shield also display substantial dispersion, with ranges of $303.50 and $239.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.