CPT code 45380: Colonoscopy with biopsy, single or multiple forceps biopsies2026 Medicare rate & RVUs in New York
Flexible colonoscopy past the splenic flexure in which one or more tissue samples are taken with biopsy forceps, reported once per session regardless of sample count.
Medicare pays $458.30–$565.57 for 45380 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 45380 covers
The endoscopist advances a flexible colonoscope through the rectum and colon, typically to the cecum, and uses biopsy forceps to sample mucosa or lesions. Common indications include suspected inflammatory bowel disease, chronic diarrhea with random biopsies for microscopic colitis, and evaluation of a mass. Small polyps removed with cold biopsy forceps are also reported with 45380. Gastroenterologists and general or colorectal surgeons perform the procedure, mostly in hospital outpatient departments and ambulatory surgery centers, with a smaller share in offices.
Report one unit per colonoscopy session regardless of the number of biopsies or sites sampled; document the sites and extent reached. Diagnostic colonoscopy 45378 is included and is not billed separately. When related colonoscopy procedures are reported together, endoscopy family pricing pays the highest-valued procedure in full and reduces each additional procedure by the family's base endoscopy value. The 0-day global includes routine same-day preoperative and postoperative care. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate. Append modifier PT when a Medicare screening colonoscopy leads to biopsy.
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.
Where 45380 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$458.30 to $565.57
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $552.32 | $201.07 |
| NYC suburbs and Long Island, NY | $565.57 | $206.16 |
| Poughkeepsie and northern NYC suburbs, NY | $521.39 | $190.39 |
| Queens, NY | $557.30 | $200.00 |
| Rest of New York | $458.30 | $171.14 |
How the 45380 rate is calculated
Each of 45380’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 · 45380
RVUs × geographic indexes × conversion factor
Work3.47
3.47 RVUs× 1.000 GPCI
Practice expense10.48
10.48 RVUs× 1.000 GPCI
Malpractice0.42
0.42 RVUs× 1.000 GPCI
Adjusted RVUs
14.3700
Conversion factor
$33.4009
Medicare rate
$479.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45380
The CMS indicators that decide how 45380 is paid alongside other services.
CMS payment indicators · 45380
Colonoscopy with biopsy, single or multiple forceps biopsies
| 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 | 3 | Endoscopy family rules apply. |
| 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
45380 without 51 · national office
$479.97
Colonoscopy with biopsy, single or multiple forceps biopsies
45380-51 · Second procedure: 50%
$239.99
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%).
45380 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45378ColonoscopyDiagnostic, no tissue removal
- 45378 is colonoscopy with no tissue sampling or intervention. Once a forceps biopsy is taken, report 45380 instead and do not add 45378.
- 45385Snare polypectomyDuring colonoscopy
- 45385 is lesion removal by snare. Tissue sampling or cold forceps removal is 45380; both are billed only when they address different lesions.
- 45384Colonoscopy polyp removalHot biopsy or bipolar cautery
- 45384 is removal using hot biopsy forceps with cautery. Cold forceps biopsy or removal without cautery stays with 45380.
- 45331SigmoidoscopyWith biopsy
- 45331 is flexible sigmoidoscopy with biopsy, examining as far as the splenic flexure. Use 45380 when the colonoscopy extends beyond the splenic flexure and includes a biopsy.
45380 billing questions
How many units are reported when several biopsies are taken from different segments?
One unit. The code covers single or multiple biopsies during the same colonoscopy, so random biopsies from the ascending, transverse, and sigmoid colon are still a single line.
Can 45380 be billed with snare polypectomy 45385 in the same session?
Yes, when the biopsy is of a different lesion than the one removed by snare. Append modifier 59 or XS to 45380 and document separate lesions; biopsy of the same lesion before snaring is not separately reported.
Which code applies when a small polyp is removed with cold biopsy forceps?
Cold forceps removal is reported with 45380. Hot biopsy forceps removal goes to 45384, and snare removal, hot or cold, goes to 45385.
What modifier is needed when a Medicare screening colonoscopy turns into a biopsy?
Report 45380 with modifier PT to identify the procedure as a screening colonoscopy converted to biopsy. The Medicare Part B deductible is waived.
Is the pathology work included in 45380?
No. The endoscopist's code covers obtaining the tissue only; the pathologist separately reports the specimen examination, commonly with 88305 for each separately submitted specimen.
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
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