CPT
43239 — Upper GI endoscopy with biopsy
High-volume procedure with predictable surprise-bill risk.
Gastroenterology
45380 — Colonoscopy, flexible, with biopsy, single or multiple
This code is used when a physician performs a full colonoscopy (camera examination of the entire large intestine) and takes one or more tissue samples (biopsies) using cold biopsy forceps.
- Typical setting: Endoscopy suite, hospital
- National avg charge (illustrative): $250-$550 Medicare allowed for professional fee (total facility + professional: $1,500-$4,000; commercial payer average ~$594 nationally per PayerPrice 2026)
- Most-disputed reason: Billing 45380 and 45385 for the same lesion: if a lesion was biopsied and then removed at the same session, only the removal code (45385) should be billed — both cannot be billed for the same polyp
What it means
What 45380 actually means
This code is used when a physician performs a full colonoscopy (camera examination of the entire large intestine) and takes one or more tissue samples (biopsies) using cold biopsy forceps. Biopsies are sent to a pathologist for analysis. This is different from polyp removal — if the lesion is removed rather than just sampled, a different code applies.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing 45380 and 45385 for the same lesion: if a lesion was biopsied and then removed at the same session, only the removal code (45385) should be billed — both cannot be billed for the same polyp
- Screening vs. diagnostic modifier: when a screening colonoscopy finds a lesion requiring biopsy, modifier -PT (Medicare) or -33 (commercial) is needed to indicate conversion from screening to diagnostic
- Separate pathology bill: patients often receive a second bill from the pathology lab — this is expected and legitimate, not a duplicate charge for the colonoscopy itself
If you see 45380 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 45380 often also see these adjacent codes on the same bill.
CPT
43644 — Laparoscopic Roux-en-Y gastric bypass with small intestine reconstruction
Verify the code matches the actual service and dose.
CPT
45378 — Diagnostic colonoscopy
If your screening colonoscopy turned diagnostic, federal rules limit your cost-share.
CPT
45385 — Colonoscopy, flexible, with removal of tumor/polyp/lesion by snare technique
Verify the code matches the actual service and dose.
Related BillBusted guides
Plain-English reads if you see 45380 on a bill.
45380 FAQ
Plain-English answers.
What does 45380 usually cost?
$250-$550 Medicare allowed for professional fee (total facility + professional: $1,500-$4,000; commercial payer average ~$594 nationally per PayerPrice 2026). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 45380?
Billing 45380 and 45385 for the same lesion: if a lesion was biopsied and then removed at the same session, only the removal code (45385) should be billed — both cannot be billed for the same polyp
What should I do if I see 45380 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 45380 before paying.
Don't pay 45380 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.