CPT code 45378: Colonoscopy, diagnostic, no tissue removal2026 Medicare rate & RVUs in Houston, TX
Reports a diagnostic examination of the colon when the endoscopist inspects the colon without performing a separately described biopsy or therapeutic intervention.
In Houston, TX, Medicare pays $382.29 for 45378 in the office and $170.35 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45378 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 45378 covers
A gastroenterologist or colorectal surgeon advances a flexible endoscope through the colon to examine the bowel, commonly for evaluation of symptoms or an abnormal finding. The service can include specimen collection by brushing or washing, but it does not describe taking tissue for biopsy or treating a lesion. It is typically performed in an endoscopy unit or hospital outpatient department, with sedation commonly provided as part of the procedural setting.
Choose this code when the documented service is diagnostic inspection rather than a more specific colonoscopy procedure. The report should support the examination performed and whether a biopsy or treatment was done; when a more specific procedure is performed, report that service rather than separately reporting the diagnostic examination. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Modifier 53 is separately priced. Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Houston, TX compares for 45378
Across 109 of 109 payment localities, the office rate for 45378 runs from $335.05 in Arkansas to $497.55 in San Benito County, CA. Houston, TX pays $382.29. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Houston, TX · this page$382.29
- Austin, TX · Texas$391.72+$9.43
- Beaumont, TX · Texas$353.89−$28.40
- Brazoria, TX · Texas$373.61−$8.68
- Dallas, TX · Texas$376.08−$6.21
- Fort Worth, TX · Texas$373.67−$8.62
- Galveston, TX · Texas$374.79−$7.50
Other areas in Texas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Rest of TexasTexas | $363.60 | $161.06 |
| Los Angeles, CACalifornia | $425.10 | $172.61 |
| Washington, DC areaDistrict of Columbia | $431.34 | $179.92 |
| Miami, FLFlorida | $409.62 | $187.44 |
| Chicago, ILIllinois | $397.87 | $183.37 |
| Manhattan, NYNew York | $434.75 | $186.74 |
| AlaskaAlaska | $441.84 | $214.53 |
| AlabamaAlabama | $339.88 | $153.13 |
| ArkansasArkansas | $335.05 | $151.71 |
| ArizonaArizona | $368.12 | $161.31 |
| Bakersfield, CACalifornia | $399.55 | $165.63 |
| Chico, CACalifornia | $398.34 | $164.41 |
| El Centro, CACalifornia | $398.40 | $164.48 |
| Fresno, CACalifornia | $398.34 | $164.41 |
| Hanford, CACalifornia | $398.34 | $164.41 |
| Madera, CACalifornia | $398.34 | $164.41 |
| Merced, CACalifornia | $398.34 | $164.41 |
| Modesto, CACalifornia | $398.34 | $164.41 |
| Napa, CACalifornia | $460.16 | $178.85 |
| Oxnard, CACalifornia | $422.90 | $170.62 |
| Redding, CACalifornia | $398.34 | $164.41 |
| Rest of CaliforniaCalifornia | $398.34 | $164.41 |
| Riverside, CACalifornia | $402.78 | $168.86 |
| Sacramento, CACalifornia | $417.65 | $169.43 |
| Salinas, CACalifornia | $416.09 | $168.72 |
| San Diego, CACalifornia | $425.62 | $170.35 |
| Marin County, CACalifornia | $486.64 | $185.70 |
| San Francisco, CACalifornia | $486.17 | $185.23 |
| San Benito County, CACalifornia | $497.55 | $189.78 |
| Santa Clara County, CACalifornia | $495.64 | $187.88 |
| San Luis Obispo, CACalifornia | $409.44 | $166.34 |
| Santa Cruz, CACalifornia | $429.49 | $170.17 |
| Santa Maria, CACalifornia | $417.58 | $168.72 |
| Santa Rosa, CACalifornia | $433.80 | $171.70 |
| Stockton, CACalifornia | $398.34 | $164.41 |
| Vallejo, CACalifornia | $459.49 | $178.18 |
| Visalia, CACalifornia | $398.34 | $164.41 |
| Yuba City, CACalifornia | $398.34 | $164.41 |
| ColoradoColorado | $392.90 | $165.81 |
| ConnecticutConnecticut | $402.98 | $173.11 |
| DelawareDelaware | $374.15 | $163.28 |
| Fort Lauderdale, FLFlorida | $392.52 | $176.31 |
| Rest of FloridaFlorida | $373.63 | $169.59 |
| Atlanta, GAGeorgia | $385.30 | $168.45 |
| Rest of GeorgiaGeorgia | $352.84 | $162.46 |
| Hawaii, Guam, HIHawaii | $407.70 | $165.03 |
| IowaIowa | $347.89 | $152.60 |
| IdahoIdaho | $350.23 | $153.87 |
| East St. Louis, ILIllinois | $371.33 | $174.97 |
| Rest of IllinoisIllinois | $363.35 | $168.48 |
| Suburban Chicago, ILIllinois | $396.38 | $177.19 |
| IndianaIndiana | $352.21 | $154.36 |
| KansasKansas | $346.52 | $153.58 |
| KentuckyKentucky | $348.28 | $158.53 |
| New Orleans, LALouisiana | $364.73 | $163.89 |
| Rest of LouisianaLouisiana | $347.83 | $158.94 |
| Metropolitan Boston, MAMassachusetts | $431.04 | $176.20 |
| Rest of MassachusettsMassachusetts | $390.70 | $165.96 |
| Baltimore area, MDMaryland | $401.89 | $172.88 |
| Rest of MarylandMaryland | $381.14 | $165.14 |
| Rest of MaineMaine | $352.27 | $155.91 |
| Southern Maine, MEMaine | $370.72 | $159.21 |
| Detroit, MIMichigan | $378.46 | $172.49 |
| Rest of MichiganMichigan | $357.40 | $162.54 |
| MinnesotaMinnesota | $375.94 | $156.32 |
| Metropolitan Kansas City, MOMissouri | $362.03 | $161.62 |
| Metropolitan St. Louis, MOMissouri | $365.73 | $162.55 |
| Rest of MissouriMissouri | $342.11 | $158.13 |
| MississippiMississippi | $338.64 | $154.87 |
| MontanaMontana | $378.07 | $164.64 |
| North CarolinaNorth Carolina | $355.86 | $156.72 |
| North DakotaNorth Dakota | $369.96 | $156.53 |
| NebraskaNebraska | $349.70 | $152.70 |
| New HampshireNew Hampshire | $386.97 | $164.79 |
| Northern New JerseyNew Jersey | $427.03 | $179.45 |
| Rest of New JerseyNew Jersey | $407.43 | $174.36 |
| New MexicoNew Mexico | $359.42 | $163.70 |
| NevadaNevada | $376.07 | $162.42 |
| NYC suburbs and Long Island, NYNew York | $445.43 | $191.66 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $410.28 | $176.57 |
| Queens, NYNew York | $437.94 | $185.66 |
| Rest of New YorkNew York | $361.12 | $158.36 |
| OhioOhio | $355.75 | $160.88 |
| OklahomaOklahoma | $347.42 | $156.82 |
| Portland, OROregon | $404.95 | $167.83 |
| Rest of OregonOregon | $373.00 | $160.42 |
| Metropolitan Philadelphia, PAPennsylvania | $393.24 | $171.06 |
| Rest of PennsylvaniaPennsylvania | $356.17 | $160.24 |
| Puerto RicoPuerto Rico | $380.73 | $164.95 |
| Rhode IslandRhode Island | $387.16 | $166.68 |
| South CarolinaSouth Carolina | $356.42 | $159.21 |
| South DakotaSouth Dakota | $369.01 | $155.57 |
| TennesseeTennessee | $348.26 | $154.25 |
| UtahUtah | $361.21 | $160.58 |
| VirginiaVirginia | $369.68 | $159.88 |
| Virgin Islands, VIUnited States Virgin Islands | $380.73 | $164.95 |
| VermontVermont | $368.75 | $157.45 |
| Rest of WashingtonWashington | $389.89 | $165.15 |
| King County, WAWashington | $439.51 | $177.63 |
| WisconsinWisconsin | $357.78 | $153.31 |
| West VirginiaWest Virginia | $350.18 | $164.71 |
| WyomingWyoming | $374.54 | $161.11 |
45378 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$335.05
$447.95
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $441.84 | 1 |
| AL | $339.88 | 1 |
| AR | $335.05 | 1 |
| AZ | $368.12 | 1 |
| CA | $398.34–$497.55 | 29 |
| CO | $392.90 | 1 |
| CT | $402.98 | 1 |
| DC | $431.34 | 1 |
| DE | $374.15 | 1 |
| FL | $373.63–$409.62 | 3 |
| GA | $352.84–$385.30 | 2 |
| GU | $407.70 | 1 |
| HI | $407.70 | 1 |
| IA | $347.89 | 1 |
| ID | $350.23 | 1 |
| IL | $363.35–$397.87 | 4 |
| IN | $352.21 | 1 |
| KS | $346.52 | 1 |
| KY | $348.28 | 1 |
| LA | $347.83–$364.73 | 2 |
| MA | $390.70–$431.04 | 2 |
| MD | $381.14–$431.34 | 3 |
| ME | $352.27–$370.72 | 2 |
| MI | $357.40–$378.46 | 2 |
| MN | $375.94 | 1 |
| MO | $342.11–$365.73 | 3 |
| MS | $338.64 | 1 |
| MT | $378.07 | 1 |
| NC | $355.86 | 1 |
| ND | $369.96 | 1 |
| NE | $349.70 | 1 |
| NH | $386.97 | 1 |
| NJ | $407.43–$427.03 | 2 |
| NM | $359.42 | 1 |
| NV | $376.07 | 1 |
| NY | $361.12–$445.43 | 5 |
| OH | $355.75 | 1 |
| OK | $347.42 | 1 |
| OR | $373.00–$404.95 | 2 |
| PA | $356.17–$393.24 | 2 |
| PR | $380.73 | 1 |
| RI | $387.16 | 1 |
| SC | $356.42 | 1 |
| SD | $369.01 | 1 |
| TN | $348.26 | 1 |
| TX | $353.89–$391.72 | 8 |
| UT | $361.21 | 1 |
| VA | $369.68–$431.34 | 2 |
| VI | $380.73 | 1 |
| VT | $368.75 | 1 |
| WA | $389.89–$439.51 | 2 |
| WI | $357.78 | 1 |
| WV | $350.18 | 1 |
| WY | $374.54 | 1 |
How the 45378 rate is calculated
Each of 45378’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45378
RVUs × geographic indexes × conversion factor
Work3.18
3.18 RVUs× 1.000 GPCI
Practice expense7.73
7.73 RVUs× 1.000 GPCI
Malpractice0.41
0.41 RVUs× 1.000 GPCI
Adjusted RVUs
11.3200
Conversion factor
$33.4009
Medicare rate
$378.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Houston, TX inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,513
- Code
- 45378
- Physician work
- 3.18
- Practice expense
- 7.73
- Malpractice
- 0.41
GPCI2026.csv
102
- Locality
- Houston, TX
- Physician work
- 1.008
- Practice expense
- 0.993
- Malpractice
- 1.376
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.18 | × 1.008 | 3.2054 |
| Practice expense | 7.73 | × 0.993 | 7.6759 |
| Malpractice | 0.41 | × 1.376 | 0.5642 |
| Total RVUs | 11.4455 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Houston, TX$382.29
Office: (3.18 × 1.008 + 7.73 × 0.993 + 0.41 × 1.376) × $33.4009 = $382.29
Facility: (3.18 × 1.008 + 1.34 × 0.993 + 0.41 × 1.376) × $33.4009 = $170.35
Payment rules and modifiers for 45378
The CMS indicators that decide how 45378 is paid alongside other services.
CMS payment indicators · 45378
Colonoscopy, diagnostic, no tissue removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45378 without 51 · national office
$378.10
Colonoscopy, diagnostic, no tissue removal
45378-51 · Second procedure: 50%
$189.05
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 45378 has changed in Houston, TX
45378 · Office / nonfacility
$382.29
Effective 2026-10-01
The base rate is $46.83 higher than on 2025-10-01, moving from $335.46 to $382.29 (14.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$335.46changed to$382.29
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.26 changed to 3.18
- Practice expense RVU 6.44 changed to 7.73
- Malpractice RVU 0.43 changed to 0.41
- Work GPCI 1.014 changed to 1.008
- Practice expense GPCI 1.003 changed to 0.993
- Malpractice GPCI 1.409 changed to 1.376
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$347.09changed to$335.46
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.51 changed to 6.44
- Malpractice RVU 0.42 changed to 0.43
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$341.42changed to$347.09
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$353.57changed to$341.42
- Conversion factor 33.8872 changed to 32.7442
- Work GPCI 1.023 changed to 1.014
- Practice expense GPCI 1.016 changed to 1.003
- Malpractice GPCI 1.154 changed to 1.409
January 1, 2023
RVU23A
$366.05changed to$353.57
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 6.66 changed to 6.51
- Malpractice RVU 0.40 changed to 0.42
- Work GPCI 1.032 changed to 1.023
- Practice expense GPCI 1.029 changed to 1.016
- Malpractice GPCI 0.900 changed to 1.154
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$365.80changed to$366.05
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 6.56 changed to 6.66
- Malpractice RVU 0.41 changed to 0.40
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$345.96changed to$365.80
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 5.75 changed to 6.56
- Work GPCI 1.026 changed to 1.032
- Practice expense GPCI 1.020 changed to 1.029
- Malpractice GPCI 0.918 changed to 0.900
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$334.49changed to$345.96
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 5.46 changed to 5.75
- Malpractice RVU 0.46 changed to 0.41
- Work GPCI 1.020 changed to 1.026
- Practice expense GPCI 1.012 changed to 1.020
- Malpractice GPCI 0.936 changed to 0.918
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$328.27changed to$334.49
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.29 changed to 5.46
- Malpractice RVU 0.47 changed to 0.46
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$325.77changed to$328.27
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 5.26 changed to 5.29
- Practice expense GPCI 1.009 changed to 1.012
- Malpractice GPCI 0.946 changed to 0.936
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$388.61changed to$325.77
- Conversion factor 35.8043 changed to 35.8887
- Work RVU 3.36 changed to 3.26
- Practice expense RVU 6.93 changed to 5.26
- Malpractice RVU 0.48 changed to 0.47
- Work GPCI 1.019 changed to 1.020
- Practice expense GPCI 1.006 changed to 1.009
- Malpractice GPCI 0.955 changed to 0.946
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$400.51changed to$388.61
- Conversion factor 35.9335 changed to 35.8043
- Work RVU 3.69 changed to 3.36
- Practice expense RVU 6.81 changed to 6.93
- Malpractice RVU 0.56 changed to 0.48
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$398.51changed to$400.51
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$396.72changed to$398.51
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 6.78 changed to 6.81
- Work GPCI 1.014 changed to 1.019
- Practice expense GPCI 1.004 changed to 1.006
- Malpractice GPCI 0.939 changed to 0.955
Held through RVU15B.
January 1, 2014
RVU14A
$410.77changed to$396.72
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 7.79 changed to 6.78
- Malpractice RVU 0.59 changed to 0.56
- Work GPCI 1.009 changed to 1.014
- Practice expense GPCI 1.002 changed to 1.004
- Malpractice GPCI 0.923 changed to 0.939
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $410.77
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $382.29 | $170.35 | RVU26D |
| 2026-07-01 | $382.29 | $170.35 | RVU26C |
| 2026-04-01 | $382.29 | $170.35 | RVU26B |
| 2026-01-01 | $382.29 | $170.35 | RVU26A |
| 2025-10-01 | $335.46 | $184.60 | RVU25D |
| 2025-07-01 | $335.46 | $184.60 | RVU25C |
| 2025-04-01 | $335.46 | $184.60 | RVU25B |
| 2025-01-01 | $335.46 | $184.60 | RVU25A |
| 2024-10-01 | $347.09 | $188.83 | RVU24D |
| 2024-07-01 | $347.09 | $188.83 | RVU24C |
| 2024-04-01 | $347.09 | $188.83 | RVU24B |
| 2024-03-09 | $347.09 | $188.83 | RVU24AR |
| 2024-01-01 | $341.42 | $185.75 | RVU24A |
| 2023-10-01 | $353.57 | $189.34 | RVU23D |
| 2023-07-01 | $353.57 | $189.34 | RVU23C |
| 2023-04-01 | $353.57 | $189.34 | RVU23B |
| 2023-01-01 | $353.57 | $189.34 | RVU23A |
| 2022-10-01 | $366.05 | $190.85 | RVU22D |
| 2022-07-01 | $366.05 | $190.85 | RVU22C |
| 2022-04-01 | $366.05 | $190.85 | RVU22B |
| 2022-01-01 | $366.05 | $190.85 | RVU22A |
| 2021-10-01 | $365.80 | $192.38 | RVU21D |
| 2021-07-01 | $365.80 | $192.38 | RVU21C |
| 2021-04-01 | $365.80 | $192.38 | RVU21B |
| 2021-01-01 | $365.80 | $192.38 | RVU21A |
| 2020-10-01 | $345.96 | $196.14 | RVU20D |
| 2020-07-01 | $345.96 | $196.14 | RVU20C |
| 2020-04-01 | $345.96 | $196.14 | RVU20B |
| 2020-01-01 | $345.96 | $196.14 | RVU20A |
| 2019-10-01 | $334.49 | $196.99 | RVU19D |
| 2019-07-01 | $334.49 | $196.99 | RVU19C |
| 2019-04-01 | $334.49 | $196.99 | RVU19B |
| 2019-01-01 | $334.49 | $196.99 | RVU19A |
| 2018-10-01 | $328.27 | $197.84 | RVU18D |
| 2018-07-01 | $328.27 | $197.84 | RVU18C |
| 2018-04-01 | $328.27 | $197.84 | RVU18B |
| 2018-01-01 | $328.27 | $197.84 | RVU18AR1 |
| 2017-10-01 | $325.77 | $197.22 | RVU17D |
| 2017-07-01 | $325.77 | $197.22 | RVU17C |
| 2017-04-01 | $325.77 | $197.22 | RVU17B |
| 2017-01-01 | $325.77 | $197.22 | RVU17A |
| 2016-10-01 | $388.61 | $201.67 | RVU16D |
| 2016-07-01 | $388.61 | $201.67 | RVU16C |
| 2016-04-01 | $388.61 | $201.67 | RVU16B |
| 2016-01-01 | $388.61 | $201.67 | RVU16A |
| 2015-10-01 | $400.51 | $224.46 | RVU15D |
| 2015-07-01 | $400.51 | $224.46 | RVU15C |
| 2015-04-01 | $398.51 | $223.34 | RVU15B |
| 2015-01-01 | $398.51 | $223.34 | RVU15A |
| 2014-10-01 | $396.72 | $222.65 | RVU14D |
| 2014-07-01 | $396.72 | $222.65 | RVU14C |
| 2014-04-01 | $396.72 | $222.65 | RVU14B |
| 2014-01-01 | $396.72 | $222.65 | RVU14A |
| 2013-10-01 | $410.77 | $220.20 | RVU13D |
| 2013-07-01 | $410.77 | $220.20 | RVU13C |
| 2013-04-01 | $410.77 | $220.20 | RVU13B |
| 2013-01-01 | $410.77 | $220.20 | RVU13AR |
Where the Houston, TX rate applies
Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.
- 45378 in Houston · multiple payment areas
- Aldine
- Atascocita
- Barrett
- 45378 in Baytown · multiple payment areas
- Bellaire
- Bunker Hill Village
- Channelview
45378 billing questions
When should 45378 be chosen instead of 45380?
Use 45378 for diagnostic inspection without tissue biopsy. When tissue is sampled for histologic examination, report the biopsy service, 45380, instead.
Can 45378 be reported with a colonoscopy that removes a polyp?
The diagnostic inspection is part of the colonoscopy with polyp removal; report the code for the removal method rather than separately billing 45378 for the same examination.
Is modifier 50 appropriate for 45378?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How should modifier 53 be handled?
CMS lists modifier 53 as separately priced for 45378. The record should support that the colonoscopy was discontinued; apply the modifier only when the circumstances meet its reporting requirements.
Does the 0-day global period include same-day care?
Yes. Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
How many units are reported for the diagnostic examination?
Report one service for the colonoscopy, not a separate unit for each segment examined.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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