CPT 45385 is a colonoscopy in which a polyp is removed with a wire snare. It is the most common outcome for people over 50: about a third of colonoscopies find at least one polyp, and removing it during the same exam is the point of the procedure. You cannot book 45385 in advance; it is billed when a polyp is found.
What the price covers
The hospital's price is the facility fee for the endoscopy unit: room, nursing, sedation monitoring, the snare and other disposables, and recovery. Physician, anesthesia and pathology are separate bills. Every removed polyp goes to pathology, so with several polyps the pathology bill can rival the facility fee.
Cash price versus insured price
With insurance, a screening colonoscopy that turns into a polyp removal is still supposed to be covered as preventive under the Affordable Care Act rules, but billing errors are common. Without insurance, the cash price listed here is what to negotiate from. Some hospitals' cash price is lower than the rate they negotiated with insurers; you are allowed to ask for the cash price even if you are insured.
Why prices vary
Expect a wide spread within one metro area. It follows the hospital, not the procedure: the same snare, the same 30 minutes, priced according to what each system has decided its chargemaster should say. Hospital-owned outpatient centers and community hospitals are usually the low end.
Questions to ask
- What is the self-pay price for 45385, and what for 45378 if no polyp is found?
- How is pathology billed, per specimen or flat?
- Is anesthesia by a nurse anesthetist or an anesthesiologist, and who bills it?