How much does Medicare pay for CPT 45384?

Medicare allowed an average of $277.07 per service and paid $225.79 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1890.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45384?

Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery. It was billed 40,459 times to 40,178 Medicare beneficiaries by 773 providers in 2024.

Does 45384 pay differently in an office than a hospital?

Yes. The allowed amount averaged $430.44 in an office setting and $268.49 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 45384 most?

Gastroenterology, with 14,076 services from 214 clinicians. Next are Ambulatory Surgical Center, General Surgery, Colorectal Surgery (Proctology).

CPT 45384

Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery

$277.07Medicare-allowed amount per service, averaged across 40,459 services

Providers submitted

$1890.52

Asking price, not received

Medicare allowed

$277.07

The fee schedule figure

Medicare paid

$225.79

Balance is patient coinsurance

Providers submitted an average of $1890.52 for this code and Medicare allowed $277.07 — 6.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $225.79 (81%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $430.44
Hospital / facility: $268.49

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 2,143 services were billed in an office setting and 38,316 in a facility.

Services: 40,459
Beneficiaries: 40,178
Providers billing it: 773
Total allowed: $11,209,975

What Medicare pays for CPT 45384

Across 40,459 services billed by 773 providers to 40,178 beneficiaries, Medicare allowed an average of $277.07 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 45384

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	14,076	13,957	$191.30	214
Ambulatory Surgical Center	12,103	12,039	$502.98	185
General Surgery	8,527	8,471	$164.99	232
Colorectal Surgery (Proctology)	4,173	4,140	$172.05	81
Internal Medicine	636	630	$218.40	21
Family Practice	626	624	$160.18	31
Emergency Medicine	187	186	$215.05	4
Vascular Surgery	80	80	$214.87	2
Critical Care (Intensivists)	24	24	$205.72	1
General Practice	14	14	$109.23	1
Surgical Oncology	13	13	$133.45	1

45384 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	4,487	$345.49	$230.97	53
Florida	4,409	$273.77	$232.19	79
Texas	3,355	$268.81	$223.25	49
Georgia	2,334	$299.27	$245.18	34
Illinois	2,064	$338.50	$272.04	30
New Jersey	1,866	$329.71	$241.74	32
New York	1,641	$382.17	$255.85	32
Maryland	1,481	$306.32	$240.41	18
Tennessee	1,457	$225.17	$200.02	32
Ohio	1,432	$233.71	$195.10	34
Arkansas	1,340	$269.18	$231.39	19
Alabama	1,336	$229.49	$201.92	40
Virginia	1,211	$271.70	$232.37	19
Kansas	986	$249.27	$219.24	24
Louisiana	952	$267.06	$235.32	22
Michigan	873	$240.43	$198.62	21
Mississippi	811	$262.81	$243.38	13
Wisconsin	759	$190.35	$163.88	20
South Carolina	720	$247.84	$210.37	23
Hawaii	713	$284.36	$200.54	9
Pennsylvania	706	$241.08	$197.85	27
North Carolina	683	$197.52	$165.65	16
South Dakota	643	$230.74	$190.14	11
Indiana	618	$198.69	$173.12	15
Oklahoma	550	$244.09	$211.35	13
Missouri	489	$181.84	$147.59	11
Kentucky	470	$225.92	$197.60	14
Nebraska	290	$186.51	$152.54	9
West Virginia	270	$258.05	$235.98	5
Minnesota	228	$191.73	$164.31	8
New Hampshire	176	$147.82	$114.21	3
Oregon	171	$166.51	$134.54	3
Massachusetts	160	$261.90	$185.29	5
Iowa	146	$253.91	$220.41	6
Connecticut	103	$312.98	$226.12	2
Delaware	93	$233.70	$174.65	4
North Dakota	85	$160.43	$121.05	2
New Mexico	69	$116.90	$84.22	4
Alaska	58	$283.72	$173.72	2
Colorado	54	$249.16	$203.77	2
Washington	50	$131.86	$101.82	2
Nevada	36	$363.41	$278.93	2
Arizona	32	$128.29	$98.31	1
Idaho	25	$170.29	$139.87	1
Puerto Rico	15	$473.30	$361.35	1
Utah	12	$214.76	$151.30	1

Related codes

45385Removal of polyps or growths of large bowel$362.33
45380Biopsy of large bowel$242.88
45378Diagnostic exam of large bowel$260.72
45381Injection beneath lining of large bowel$181.72
45390Removal of large bowel tissue$582.65
45330Diagnostic exam of lower portion of large bowel$98.83
45388Destruction of polyp or growth of large bowel$491.91
45300Diagnostic exam of rectum and lower large bowel$116.96
45331Biopsy of lower large bowel$291.11
45382Control of bleeding of upper large bowel$290.18
45398Banding of hemorrhoids$404.14

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.