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CPT code 45380: Colonoscopy with biopsy, single or multiple forceps biopsies2026 Medicare rate & RVUs in Puerto Rico

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.

CMS RVU26DEffective Oct 1, 2026One payment locality1.3M Medicare services in 2024

In Puerto Rico, Medicare pays $483.61 for 45380 in the office and $178.01 when it’s performed in a hospital or facility.

$483.61Office (non-facility)
$178.01Hospital or facility
+0.8%vs the national office rate ($479.97)

Check a contract rate as a % of Medicare · 45380 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 45380 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 45380 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for 45380

Across 109 of 109 payment localities, the office rate for 45380 runs from $423.81 in Arkansas to $640.93 in San Benito County, CA. Puerto Rico pays $483.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

45380 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$483.61
  2. Los Angeles, CA · California$544.07+$60.46
  3. Washington, DC area · District of Columbia$550.12+$66.51
  4. Miami, FL · Florida$515.77+$32.16
  5. Chicago, IL · Illinois$500.70+$17.09
  6. Manhattan, NY · New York$552.32+$68.71
  7. Alaska · Alaska$554.38+$70.77

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

45380 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$430.13$165.63
ArkansasArkansas$423.81$164.15
ArizonaArizona$467.10$174.19
Bakersfield, CACalifornia$510.29$179.00
Chico, CACalifornia$509.04$177.74
El Centro, CACalifornia$509.11$177.81
Fresno, CACalifornia$509.04$177.74
Hanford, CACalifornia$509.04$177.74

45380 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$423.81

$574.99

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
45380 office rate range by state
State / territoryOffice rate rangeLocalities
AK$554.381
AL$430.131
AR$423.811
AZ$467.101
CA$509.04–$640.9329
CO$500.691
CT$512.191
DC$550.121
DE$474.931
FL$471.63–$515.773
GA$444.86–$488.742
GU$522.021
HI$522.021
IA$441.761
ID$444.571
IL$457.42–$501.064
IN$447.211
KS$439.411
KY$439.921
LA$439.13–$461.232
MA$497.53–$551.092
MD$484.18–$550.123
ME$446.66–$471.642
MI$451.33–$477.342
MN$480.251
MO$431.30–$463.203
MS$427.651
MT$479.941
NC$451.451
ND$471.641
NE$444.291
NH$492.571
NJ$518.17–$544.232
NM$453.741
NV$477.981
NY$458.30–$565.575
OH$449.631
OK$439.391
OR$474.40–$517.092
PA$450.50–$499.122
PR$483.611
RI$492.211
SC$451.261
SD$470.661
TN$441.621
TX$447.47–$498.918
UT$457.541
VA$469.90–$550.122
VI$483.611
VT$469.541
WA$496.68–$562.662
WI$455.561
WV$440.161
WY$476.321

See 45380 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,516

Code
45380
Physician work
3.47
Practice expense
10.48
Malpractice
0.42

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 45380 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.47× 1.0003.4700
Practice expense10.48× 1.01110.5953
Malpractice0.42× 0.9850.4137
Total RVUs14.4790
Conversion factor× 33.4009

Office rate, Puerto Rico$483.61

Office: (3.47 × 1 + 10.48 × 1.011 + 0.42 × 0.985) × $33.4009 = $483.61

Facility: (3.47 × 1 + 1.43 × 1.011 + 0.42 × 0.985) × $33.4009 = $178.01

Open 45380 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 45380

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 45380
CodeHow it relatesOffice range, Puerto Rico
Same family
45378Colonoscopy, diagnostic, no tissue removalDiagnostic colonoscopy base code; included in 45380 and used for family pricing reductions.$380.73
Often billed with
45385Snare polypectomy, during colonoscopySnare polypectomy of a separate lesion; 45380 needs modifier 59 or XS.$503.43
45381Colonoscopy injection, directed submucosal injectionSubmucosal injection, such as tattooing a biopsied mass site for later localization.$494.08
88305Tissue pathology exam, level IV specimenPathologist's surgical pathology examination of a separately submitted colon biopsy specimen.$70.63
43239EGD with biopsy, single or multiple biopsiesEGD with biopsy performed in the same session; its endoscopy family is separate from colonoscopy.$422.36
Used instead
45384Colonoscopy polyp removal, hot biopsy or bipolar cauteryHot biopsy forceps lesion removal instead of cold forceps biopsy or removal.$543.37
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when the examination does not extend beyond the splenic flexure.$326.01
45392Colonoscopy with EUS, with needle samplingColonoscopy with endoscopic ultrasound-guided needle sampling rather than forceps biopsy.No office rate

How 45380 has changed in Puerto Rico

45380 · Office / nonfacility

$483.61

Effective 2026-10-01

The base rate is $67.21 higher than on 2025-10-01, moving from $416.40 to $483.61 (16.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $416.40changed to$483.61

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.56 changed to 3.47
    • Practice expense RVU 8.79 changed to 10.48
    • Malpractice RVU 0.47 changed to 0.42
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $434.24changed to$416.40

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.99 changed to 8.79
    • Malpractice RVU 0.44 changed to 0.47

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $427.15changed to$434.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $444.10changed to$427.15

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.04 changed to 8.99
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $441.89changed to$444.10

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $462.65changed to$441.89

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.33 changed to 9.04
    • Malpractice RVU 0.41 changed to 0.44
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $464.01changed to$462.65

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.25 changed to 9.33
    • Malpractice RVU 0.42 changed to 0.41

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $439.95changed to$464.01

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.16 changed to 9.25
    • Malpractice RVU 0.41 changed to 0.42
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $426.69changed to$439.95

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.76 changed to 8.16
    • Malpractice RVU 0.47 changed to 0.41
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $417.52changed to$426.69

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.51 changed to 7.76
    • Malpractice RVU 0.48 changed to 0.47

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $368.00changed to$417.52

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.46 changed to 7.51
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $367.40changed to$368.00

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.66 changed to 3.56
    • Practice expense RVU 9.16 changed to 7.46
    • Malpractice RVU 0.49 changed to 0.48
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $371.08changed to$367.40

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 4.43 changed to 3.66
    • Practice expense RVU 8.09 changed to 9.16
    • Malpractice RVU 0.66 changed to 0.49

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $369.23changed to$371.08

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $364.71changed to$369.23

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.06 changed to 8.09
    • Malpractice RVU 0.64 changed to 0.66
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $370.47changed to$364.71

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.28 changed to 8.06
    • Malpractice RVU 0.67 changed to 0.64
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $370.47

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$483.61$178.01RVU26D
2026-07-01$483.61$178.01RVU26C
2026-04-01$483.61$178.01RVU26B
2026-01-01$483.61$178.01RVU26A
2025-10-01$416.40$192.95RVU25D
2025-07-01$416.40$192.95RVU25C
2025-04-01$416.40$192.95RVU25B
2025-01-01$416.40$192.95RVU25A
2024-10-01$434.24$197.25RVU24D
2024-07-01$434.24$197.25RVU24C
2024-04-01$434.24$197.25RVU24B
2024-03-09$434.24$197.25RVU24AR
2024-01-01$427.15$194.03RVU24A
2023-10-01$444.10$199.87RVU23D
2023-07-01$441.89$199.60RVU23C
2023-04-01$441.89$199.60RVU23B
2023-01-01$441.89$199.60RVU23A
2022-10-01$462.65$203.12RVU22D
2022-07-01$462.65$203.12RVU22C
2022-04-01$462.65$203.12RVU22B
2022-01-01$462.65$203.12RVU22A
2021-10-01$464.01$204.44RVU21D
2021-07-01$464.01$204.44RVU21C
2021-04-01$464.01$204.44RVU21B
2021-01-01$464.01$204.44RVU21A
2020-10-01$439.95$209.31RVU20D
2020-07-01$439.95$209.31RVU20C
2020-04-01$439.95$209.31RVU20B
2020-01-01$439.95$209.31RVU20A
2019-10-01$426.69$211.84RVU19D
2019-07-01$426.69$211.84RVU19C
2019-04-01$426.69$211.84RVU19B
2019-01-01$426.69$211.84RVU19A
2018-10-01$417.52$213.06RVU18D
2018-07-01$417.52$213.06RVU18C
2018-04-01$417.52$213.06RVU18B
2018-01-01$417.52$213.06RVU18AR1
2017-10-01$368.00$195.96RVU17D
2017-07-01$368.00$195.96RVU17C
2017-04-01$368.00$195.96RVU17B
2017-01-01$368.00$195.96RVU17A
2016-10-01$367.40$184.14RVU16D
2016-07-01$367.40$184.14RVU16C
2016-04-01$367.40$184.14RVU16B
2016-01-01$367.40$184.14RVU16A
2015-10-01$371.08$224.65RVU15D
2015-07-01$371.08$224.65RVU15C
2015-04-01$369.23$223.54RVU15B
2015-01-01$369.23$223.54RVU15A
2014-10-01$364.71$222.42RVU14D
2014-07-01$364.71$222.42RVU14C
2014-04-01$364.71$222.42RVU14B
2014-01-01$364.71$222.42RVU14A
2013-10-01$370.47$217.07RVU13D
2013-07-01$370.47$217.07RVU13C
2013-04-01$370.47$217.07RVU13B
2013-01-01$370.47$217.07RVU13AR

Price 45380 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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

Show the CMS file lines behind this rate
RVUs for 45380PPRRVU2026_Oct_nonQPP.csv, line 5,516 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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