Colonoscopy, diagnostic
A diagnostic colonoscopy — done because of symptoms or a positive screening test. Different from a routine screening colonoscopy.
Based on typical US negotiated and cash-pay rates. Hospital charges can run significantly higher — often 2–10x these numbers. If your bill is well above this range, it's worth questioning.
- Screening colonoscopies are covered 100% by most insurance under the ACA. If yours was screening but billed diagnostic, appeal.
- Anesthesia billed separately by an out-of-network provider without your consent.
- Facility fee, physician fee, AND pathology fee all significantly above local averages.
If the colonoscopy was scheduled as a routine screening but a polyp was removed, ACA guidance says it should remain screening — ask your insurer to reprocess.
Frequently asked questions
What does CPT code 45378 mean?
A diagnostic colonoscopy — done because of symptoms or a positive screening test. Different from a routine screening colonoscopy. In billing terms it's categorized as "Colonoscopy, diagnostic" under Procedures.
How much should CPT 45378 cost?
Typical negotiated and cash-pay rates run about $800–$3,500. Hospital list prices are often 2–10× higher, but insurers rarely pay those. If your bill is well above the top of this range, ask for an itemized bill and compare.
Is CPT 45378 covered by insurance?
Most commercial plans and Medicare cover colonoscopy, diagnostic when it's medically necessary and coded correctly. Denials usually come from missing prior authorization, incorrect modifiers, or the payer disputing medical necessity — all of which can be appealed.
What should I do if CPT 45378 looks wrong on my bill?
If the colonoscopy was scheduled as a routine screening but a polyp was removed, ACA guidance says it should remain screening — ask your insurer to reprocess.
Can I dispute a charge for CPT 45378?
Yes. You have the right to request an itemized bill, dispute the coding with the provider's billing office, and appeal the insurer's decision. Federal rules (including the No Surprises Act for emergency and out-of-network ancillary services) protect you from many surprise charges. BillCheck can generate the appeal or negotiation letter for you.
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BillCheck provides informational analysis only and is not legal, medical, or financial advice. Verify all details before submitting any correspondence to insurers or providers. Prices shown are typical ranges and vary by region, payer, and facility.