45385
Colonoscopy / Removal of polyps or growths of large bowel using an endoscope
Our Work > Good Faith Estimates > Colonoscopy
Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Colonoscopy/Removal of Polyps or Growths of Large Bowel Using an Endoscope appears on both lists, and there is a standard service package available for it. It is one of the 11 shoppable services cross-mapped from SSP with TIC + Hospital Requirement. Moreover, this is a very common procedure performed millions of times per year in the United States.
Screening tests play a key role in detecting polyps before they become cancerous. These tests can also help find colorectal cancer in its early stages, when you have a good chance of recovery. If polyps are found, your doctor may remove them immediately or take tissue samples (biopsies) for analysis. Your doctor is likely to remove all polyps discovered during a bowel examination. This service package reflects the colonoscopy procedure with polyp removal.
Colonoscopies with growth removal may be performed using multiple techniques, which may each carry a different cost. This service package bundles the more common approach, snare technique. More complex cases may carry additional associated costs; this package includes optional fees if additional growth removal is required. Your service utilization may vary for a number of reasons, including your unique clinical profile and where you receive your services.
This Service Package was generated using historical data from outpatient claims. However, this service package may also be performed in other settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 50%
- Free standing ASC: 50%
- Office: Discuss with your provider
Item Definitions
Index
Index
this is the fee for the service being defined; note that other codes may be used to define a similar service
Facility Fee
Facility Fee
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
Professional Fee
Professional Fee
these fees are paid to clinicians for the work associated with this service
Optional Fee
Optional Fee
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
Ancillary Service
Ancillary Service
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
| association | base_code | code_type | example_unit_price | item_type | name |
|---|---|---|---|---|---|
| 1 | 45385 | CPT | $1,155 | index | Colonoscopy, removal of tumor(s), polyp(s), or lesions with snare |
| 1 | 45385 | CPT | $545 | professional_fee | Colonoscopy, removal of tumor(s), polyp(s), or lesions with snare |
| 88305 | CPT | $264 | facility_fee | Surgical Pathology Level 4 | |
| 0.817 | 88305 | CPT | 250 | professional_fee | Surgical Pathology Level 4 |
| 812 | CPT | $357 | professional_fee | Anesthesia | |
| 0.759374405 | 636 | Revenue Code | facility_fee | Drugs requiring detailed coding | |
| 0.726856362 | 750 | Revenue Code | facility_fee | Gastrointestinal services | |
| 0.474733933 | J2704 | HCPCS | $37 | facility_fee | Propofol injection |
| 0.426112617 | 310 | Revenue Code | facility_fee | Laboratory Pathology | |
| 0.392719516 | 312 | Revenue Code | optional_fee | Laboratory Histology | |
| 710 | Revenue Code | ancillary_service | Recovery Room | ||
| 0.344014547 | 370 | Revenue Code | ancillary_service | Anesthesia | |
| 0.305306155 | J2250 | HCPCS | 51 | optional_fee | Midazolam hydrochloride injection |
| 45380 | CPT | $852 | optional_fee [facility] | Colonoscopy, flexible; with biopsy, single or multiple. | |
| 45380 | CPT | $175 | optional_fee [professional] | Colonoscopy, flexible; with biopsy, single or multiple. |
Captured Spending (N=500,000)
| Decile | Base Fee (Facility + Professional) | Base Fee + Optional Fees |
| 1 | 4% | 2% |
| 2 | 1% | 0% |
| 3 | 3% | 0% |
| 4 | 10% | 1% |
| 5 | 3% | 1% |
| 6 | 10% | 2% |
| 7 | 11% | 3% |
| 8 | 4% | 4% |
| 9 | 4% | 6% |
| 10 | 49% | 79% |
Our Work > Good Faith Estimates > Colonoscopy