What this is, in plain language
A colonoscopy during which one or more tissue samples are taken for the lab to examine.
Why a clinician orders it
When the doctor sees something during the exam that needs to be sampled — inflammation, a polyp, or a suspicious area.
Medical necessity — what insurers usually look at
Even if scheduled as screening, finding and removing a polyp may change how the visit is billed. Under ACA, polyp removal during a screening colonoscopy is now covered without cost-share for most commercial plans and Medicare.
Documentation to ask about
- ✓Reason for the procedure
- ✓Whether scheduled as screening or diagnostic
- ✓Anesthesia plan and provider
Questions for your provider
- ?If a polyp is removed today, how will the visit be billed?
- ?Are the anesthesia and pathology labs in my network?
Why this code is in our seed set
Top-billed therapeutic colonoscopy code; included in the CMS Top 200 Ranked by Services.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •CMS guidance on colorectal cancer screening cost-sharing (2022)
- •AMA CPT code 45380 descriptor
Terms you'll see
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.