Colonoscopy With Biopsy price: Medicare anchor and facility lever
Anchor for Colonoscopy With Biopsy - CPT 45380
$185.64
Nonfacility PFS $477.34; facility professional PFS $185.64.
Hospital OPPS facility anchor, this code billed alone: $1,222.56 (APC 5312, Level 2 Lower GI Procedures; national unadjusted, before wage-index adjustment).
CPT 45380 is what a colonoscopy becomes when one or more tissue samples are taken. That change does three things to the bill: a higher professional anchor, a higher hospital APC, and a new pathology charge. If the visit started as a Medicare screening, it also changes what the patient owes.
CPT code
45380
Colonoscopy, flexible; with biopsy, single or multiple
CPT 45380 is colonoscopy with biopsy. Diagnostic colonoscopy without biopsy is 45378, and polyp removal by snare is 45385. The anchor changes with the code actually billed.
The codes this visit can be billed under
| CPT | PFS office or global | PFS facility (professional) | Global period | Hospital single-service APC | Minimum Medicare copay at hospital |
|---|---|---|---|---|---|
| 45380 (this page) | $477.34 | $185.64 | 0 days | $1,222.56 (APC 5312) | $244.52 |
| 45378 | $378.46 | $172.49 | 0 days | $950.10 (APC 5311) | $190.02 |
| 45385 | $500.01 | $233.13 | 0 days | $1,222.56 (APC 5312) | $244.52 |
| 88305 | $69.02 | $69.02 | not a surgical global | $53.24 (APC 5671) | $10.65 |
In CY2026, 45380 maps to hospital APC 5312 at $1,222.56, with a minimum unadjusted copayment of $244.52, against APC 5311 for diagnostic 45378. The professional anchors for Michigan Locality 01 are $477.34 nonfacility and $185.64 facility.
Tissue examination is billed by the pathologist, commonly under CPT 88305, whose CY2026 global anchor is $69.02. For a Medicare screening that turns into a biopsy, Medicare.gov says the patient pays 15 percent of the approved amount for the provider and a 15 percent facility coinsurance, with no Part B deductible.
When the procedure is diagnostic rather than a Medicare screening, standard Part B cost sharing applies. In a hospital, the minimum unadjusted facility copayment for 45380 is $244.52, and the endoscopist's coinsurance is figured on the $185.64 facility professional anchor. The CMS fee schedule lists a 0-day global period for 45380, so follow-up visits are separate services.
A second lesion-removal code, 45384, has a CY2026 facility professional anchor of $215.62 and maps to the same APC 5312; CMS Addendum B lists 45380, 45384 and 45385 with status indicator T.
Inside and outside the 45380 anchor
Covered by the anchor
- Endoscopist professional fee for colonoscopy with biopsy (PFS anchor below)
- Use of the endoscopy suite and standard recovery monitoring in the facility payment
Billed outside it
- Anesthesia or sedation billed separately
- Pathology for the biopsy specimen (for example 88305)
- Bowel prep supplies
- The pre-procedure visit and follow-up visit when billed separately
Why prices vary for CPT 45380
Colonoscopy with biopsy has the same three moving layers as diagnostic colonoscopy, plus pathology when tissue is taken: the endoscopist professional fee, the facility fee (hospital OPPS versus ASC versus office), and anesthesia and pathology. The facility fee is the largest lever, and a quote that names only the professional figure is missing most of the bill.
Ask where the procedure will be performed (hospital, ASC, or office), whether anesthesia will bill separately, and what pathology will cost if a biopsy is taken. Get each layer in writing.
Questions specific to Colonoscopy with biopsy
- If the procedure is planned as screening, how will it be coded if a biopsy is taken?
- What is the written price for 45380 in this setting, including the facility fee?
- Which lab examines the tissue, and does it bill you directly?
- Who provides sedation or anesthesia, and is that fee in the quote?
Colonoscopy With Biopsy: billing questions
Why did my bill change when a biopsy was taken?
The code moves from 45378 to 45380, which has a higher professional anchor and, in a hospital, maps to a higher APC. A pathology bill for the tissue examination also appears.
What do people with Medicare pay if a screening colonoscopy includes a biopsy?
Medicare.gov says you pay 15 percent of the Medicare-approved amount for the provider's services and a 15 percent coinsurance to the hospital or surgery center, and the Part B deductible does not apply.
Is the pathology fee part of the colonoscopy price?
Usually not. The pathologist bills separately for examining tissue. Ask the facility which lab it uses and whether that lab is in your network.
Is snare polyp removal billed under 45380?
No. Removal by snare technique is 45385, with a CY2026 facility professional anchor of $233.13. In a hospital it maps to the same APC as 45380. If both a biopsy and a snare removal are performed, the claim can show more than one code; ask the facility how it prices that case.