Colonoscopy with Polypectomy
CPT Code: 45385
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Check My Bill for Colonoscopy with Polypectomy →Understanding the cost of Colonoscopy with Polypectomy
What does the Medicare rate mean?
The Medicare rate of $354.25 is the amount the federal government pays providers for CPT 45385under the Medicare Physician Fee Schedule. It’s the most widely published benchmark for what a procedure "should" cost and is used as a reference point by commercial insurers when negotiating their own rates.
What do commercial insurers pay?
Commercial insurers (Blue Cross, Aetna, UnitedHealth, etc.) negotiate rates independently with each provider network. As a rule of thumb, these rates fall in the $425.10 – $708.50 range for Colonoscopy with Polypectomy — roughly 1.2 to 2 times Medicare. If you were billed significantly more, the excess may be negotiable.
What if I was billed more than the commercial range?
Bills above the typical commercial range are common, especially for uninsured or out-of-network patients who receive chargemaster (list) prices. You have several options:
- Ask for the Medicare rate or self-pay discount — many providers will accept this immediately.
- Request an itemized bill — billing errors are common and can account for hundreds or thousands of dollars.
- Appeal if you have insurance — if the procedure was denied or you were billed out-of-network, you have the right to appeal.
- Ask about financial assistance — nonprofit hospitals are required by law to offer charity care programs.
How procedure charges like this are billed
Outpatient procedures are frequently subject to bundling rules: certain steps are considered part of a larger procedure and should not be billed separately. Unbundling — charging individually for components that belong to one procedure — is one of the most common ways a procedure bill becomes inflated.
Common billing problems with procedure charges
Unbundled procedure components
National Correct Coding Initiative (NCCI) edits define which services should be billed together. Separate charges for steps that are part of the main procedure may be unbundling.
Improper use of modifiers to bypass bundling
Modifiers like 59 are sometimes applied to force separate payment for services that should be bundled. If a modifier looks like it was used to unbundle routine steps, it is worth questioning.
Add-on charges for standard supplies
Routine supplies and standard equipment are often included in the procedure price. Separate line items for them can indicate over-itemization.
How to push back on this charge
Request the itemized bill and compare line items against the main procedure code. Ask the billing office to confirm that separately billed components are not subject to bundling edits.
Frequently asked questions
How much does Colonoscopy with Polypectomy cost without insurance?
Without insurance, you may be billed the chargemaster (list) rate, which can be 3–10× the Medicare rate. For Colonoscopy with Polypectomy, that could mean a bill of $1,062.75–$1,771.25 or more. Always ask for the self-pay or cash-pay rate before accepting the listed price — providers often offer significant discounts.
What is CPT code 45385?
CPT 45385 is the Current Procedural Terminology code assigned to Colonoscopy with Polypectomy. It’s used by providers, insurers, and Medicare to identify and bill for this specific service. You’ll find it on your Explanation of Benefits (EOB) or itemized bill.
Can I negotiate the cost of Colonoscopy with Polypectomy?
Yes. Negotiating medical bills is common and often successful. Referencing the Medicare rate of $354.25 gives you a credible, federally published benchmark to anchor the conversation. Many providers will accept 1–1.5× Medicare as a cash settlement.