How much does Medicare pay for CPT 45385?

Medicare allowed an average of $362.33 per service and paid $298.72 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1846.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45385?

Removal of polyps or growths of large bowel using an endoscope with mechanical snare. It was billed 1,528,359 times to 1,516,071 Medicare beneficiaries by 16,464 providers in 2024.

Does 45385 pay differently in an office than a hospital?

Yes. The allowed amount averaged $351.93 in an office setting and $362.79 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 45385 most?

Gastroenterology, with 891,610 services from 11,543 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 45385

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

$362.33Medicare-allowed amount per service, averaged across 1,528,359 services

Providers submitted

$1846.86

Asking price, not received

Medicare allowed

$362.33

The fee schedule figure

Medicare paid

$298.72

Balance is patient coinsurance

Providers submitted an average of $1846.86 for this code and Medicare allowed $362.33 — 5.1× 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 $298.72 (82%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $351.93
Hospital / facility: $362.79

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 64,696 services were billed in an office setting and 1,463,663 in a facility.

Services: 1,528,359
Beneficiaries: 1,516,071
Providers billing it: 16,464
Total allowed: $553,770,316

What Medicare pays for CPT 45385

Across 1,528,359 services billed by 16,464 providers to 1,516,071 beneficiaries, Medicare allowed an average of $362.33 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 45385

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	891,610	884,081	$247.85	11,543
Ambulatory Surgical Center	509,054	505,402	$592.89	1,787
Internal Medicine	50,631	50,151	$250.16	772
General Surgery	47,795	47,406	$235.30	1,550
Colorectal Surgery (Proctology)	22,071	21,887	$239.07	615
Family Practice	3,398	3,380	$244.52	120
Hospitalist	1,400	1,384	$250.51	24
Emergency Medicine	547	546	$231.08	9
General Practice	406	398	$241.46	8
Osteopathic Manipulative Medicine	374	372	$244.02	6
Thoracic Surgery	176	176	$239.07	3
Anesthesiology	151	149	$322.10	4
Endocrinology	122	120	$261.19	1
Pediatric Medicine	121	120	$263.52	3
Gynecological Oncology	106	104	$263.12	1

45385 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	150,760	$434.47	$303.31	1,436
Florida	118,690	$370.61	$313.91	1,145
Texas	107,081	$359.40	$305.54	1,148
Pennsylvania	76,182	$356.13	$299.60	856
New York	67,499	$403.06	$294.68	1,104
North Carolina	64,226	$363.34	$316.18	558
Illinois	57,673	$331.16	$266.43	668
Ohio	57,094	$341.94	$294.70	683
New Jersey	46,856	$414.52	$315.93	573
Massachusetts	43,639	$325.96	$254.71	477
Maryland	43,011	$398.83	$324.24	370
Georgia	42,309	$368.40	$311.69	461
Washington	38,836	$375.37	$295.57	387
Virginia	38,457	$322.49	$262.69	404
Indiana	37,284	$323.35	$280.27	385
South Carolina	37,080	$346.75	$301.87	264
Tennessee	34,997	$338.27	$304.76	321
Michigan	33,796	$339.37	$284.04	496
Arizona	33,231	$374.37	$313.25	330
Missouri	29,329	$314.57	$269.61	334
Colorado	28,755	$385.27	$322.42	272
Wisconsin	24,910	$291.84	$251.35	321
Louisiana	22,920	$340.12	$303.34	234
Minnesota	22,506	$334.74	$278.47	367
Kentucky	20,428	$307.31	$264.64	252
Oregon	19,126	$380.61	$301.29	242
Mississippi	18,371	$338.80	$312.59	120
Iowa	17,208	$325.79	$291.38	143
Connecticut	16,622	$380.69	$289.22	239
Alabama	16,112	$310.34	$280.34	209
Arkansas	15,141	$330.84	$295.72	135
Nebraska	15,074	$357.20	$309.46	125
Oklahoma	14,676	$319.35	$274.99	163
Kansas	14,407	$326.27	$286.61	159
New Hampshire	10,956	$312.89	$259.03	89
Nevada	10,757	$410.12	$332.46	96
Delaware	10,348	$386.27	$316.39	63
Idaho	9,203	$338.77	$296.04	76
Utah	9,022	$330.38	$281.52	106
New Mexico	6,220	$357.88	$299.06	67
South Dakota	5,883	$292.64	$256.50	61
Montana	5,655	$308.80	$259.14	45
Rhode Island	5,636	$385.65	$318.80	60
Maine	5,165	$293.22	$244.62	63
Alaska	4,311	$472.86	$320.71	56
Hawaii	4,179	$426.37	$313.32	50
West Virginia	3,850	$247.34	$201.48	65
North Dakota	3,713	$270.41	$228.15	44
Vermont	3,206	$286.90	$244.43	41
District of Columbia	2,727	$312.82	$235.11	47
Wyoming	2,599	$380.44	$323.45	28
Puerto Rico	288	$375.15	$310.38	17
U.S. Virgin Islands	196	$289.82	$263.94	3
Guam	115	$399.44	$311.79	4
ZZ	44	$235.80	$179.48	2

Related codes

45380Biopsy of large bowel$242.88
45378Diagnostic exam of large bowel$260.72
45384Removal of polyps or growths of large bowel$277.07
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.