CPT 45380 is a colonoscopy during which the doctor takes one or more tissue samples for the laboratory. It starts as an ordinary colonoscopy; the biopsy is decided during the exam, so most patients are scheduled for a diagnostic or screening colonoscopy and end up with this code instead.
What the price covers
The hospital's number is the facility fee for the endoscopy suite, sedation nursing, recovery and supplies, including the biopsy forceps. The gastroenterologist, the anesthesia provider and the pathologist who reads the sample bill separately. Pathology alone commonly adds $100 to $400 per specimen, so ask how many samples are expected.
How this relates to the other colonoscopy codes
- 45378: colonoscopy, nothing removed
- 45380: colonoscopy with biopsy (this page)
- 45385: colonoscopy with polyp removal by snare
A hospital's prices for the three usually sit close together, with biopsy and polyp removal slightly above the base code. If a hospital lists only one of them, use it as a guide for the others and confirm by phone.
Why prices vary
The range between hospitals in the same metro area is commonly several times. Ownership and size drive it more than geography: large systems and teaching hospitals list higher charges; community hospitals list lower ones. Cash prices are often far below the gross charge because most hospitals apply a fixed self-pay discount.
Questions to ask
- What is the self-pay price for 45380, and does it include pathology?
- Who bills for anesthesia, and what is their cash rate?
- If no biopsy is needed after all, will you bill 45378 instead?