What insurance policy changes affect CPT 45385?

There are 9 tracked policy changes affecting CPT 45385, including updates from Harvard Pilgrim Health Care, BCBS Oklahoma, BCBS Montana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 45385?

Payers that have issued tracked updates for CPT 45385 include: Harvard Pilgrim Health Care, BCBS Oklahoma, BCBS Montana, BCBS New Mexico, BCBS Illinois, BCBS Texas, Aetna, Medical Mutual of Ohio, Cigna.

How do I get notified when CPT 45385 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 45385. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 45385?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

45385 — A doctor looks inside your colon with a camera and removes a problematic growth or tissue found during the exam.: Insurance Policy Changes

45385 Insurance Policy Changes

CPT 45385, in plain terms, covers A doctor looks inside your colon with a camera and removes a problematic growth or tissue found during the exam. CPT 45385 is referenced in 9 tracked payer policy changes from Harvard Pilgrim Health Care, BCBS Oklahoma, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 45385 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Colonoscopy updates

Harvard Pilgrim Health Care·Effective Oct 1, 2026

Effective October 1, 2026, Harvard Pilgrim Health Care Commercial and Tufts Health Direct are reclassifying many colonoscopy-related medical conditions from preventive to diagnostic or therapeutic services. This means affected services will now require patient cost-sharing. When a preventive screening colonoscopy becomes diagnostic/therapeutic (e.g., biopsy, polypectomy), providers must bill with a preventive diagnosis code and modifier 33 in the first modifier field.

45385 Insurance Policy Changes

Colonoscopy updates

New Claims Editing Rules To Be Implemented in July 2026

New Claims Editing Rules To Be Implemented in July 2026

New Claims Editing Rules To Be Implemented in July 2026

New Claims Editing Rules To Be Implemented in July 2026

New Claims Editing Rules To Be Implemented in July 2026

OfficeLink Updates - April 2025 notices and reminders (PDF)

Coding Follow-Up Colonoscopies Correctly for Medicare Advantage Members

Early screening saves lives: Colorectal cancer doesn’t wait for age