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CPT code 45381: Colonoscopy injection, directed submucosal injection2026 Medicare rate & RVUs in North Carolina

Colonoscopy with directed submucosal injection is reported when an endoscopist injects beneath a colonic lesion to lift it or mark its location.

CMS RVU26DEffective Oct 1, 2026One payment locality81.9K Medicare services in 2024

In North Carolina, Medicare pays $461.11 for 45381 in the office and $169.43 when it’s performed in a hospital or facility.

$461.11Office (non-facility)
$169.43Hospital or facility
−6.0%vs the national office rate ($490.33)

Check a contract rate as a % of Medicare · 45381 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 45381 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 45381 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 45381 covers

During colonoscopy, the endoscopist directs material into the tissue layer beneath the colonic lining. Common reasons include raising a flat lesion to facilitate endoscopic treatment or tattooing a lesion site for later localization. Gastroenterologists and colorectal surgeons typically perform the service in an endoscopy unit, ambulatory surgery center, hospital, or appropriately equipped office.

Report the service when the procedure record identifies the injection site, purpose, and substance or marking method. Injections during an endoscopic mucosal resection are included in the resection service; do not separately report this code for that same injection. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this colon procedure. Medicare does not pay an assistant-at-surgery service for this code; 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 North Carolina compares for 45381

Across 109 of 109 payment localities, the office rate for 45381 runs from $432.71 in Arkansas to $655.86 in San Benito County, CA. North Carolina pays $461.11. The RVUs are the same everywhere; the geographic indexes change the dollars.

45381 in North Carolina vs other payment areas
  1. North Carolina · this page$461.11
  2. Los Angeles, CA · California$556.32+$95.21
  3. Washington, DC area · District of Columbia$562.32+$101.21
  4. Miami, FL · Florida$526.55+$65.44
  5. Chicago, IL · Illinois$511.11+$50.00
  6. Manhattan, NY · New York$564.35+$103.24
  7. Alaska · Alaska$565.40+$104.29

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

45381 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$439.19$165.63
ArkansasArkansas$432.71$164.15
ArizonaArizona$477.13$174.19
Bakersfield, CACalifornia$521.64$179.00
Chico, CACalifornia$520.38$177.74
El Centro, CACalifornia$520.45$177.81
Fresno, CACalifornia$520.38$177.74
Hanford, CACalifornia$520.38$177.74

45381 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.

$432.71

$588.12

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

View every state and territory as a table
45381 office rate range by state
State / territoryOffice rate rangeLocalities
AK$565.401
AL$439.191
AR$432.711
AZ$477.131
CA$520.38–$655.8629
CO$511.711
CT$523.341
DC$562.321
DE$485.161
FL$481.52–$526.553
GA$454.10–$499.262
GU$533.791
HI$533.791
IA$451.231
ID$454.101
IL$466.87–$511.704
IN$456.811
KS$448.771
KY$449.131
LA$448.29–$470.972
MA$508.43–$563.452
MD$494.66–$562.323
ME$456.19–$481.912
MI$460.78–$487.332
MN$490.901
MO$440.23–$473.053
MS$436.571
MT$490.301
NC$461.111
ND$481.991
NE$453.851
NH$503.351
NJ$529.48–$556.242
NM$463.231
NV$488.341
NY$468.14–$577.885
OH$459.081
OK$448.631
OR$484.72–$528.592
PA$460.00–$509.902
PR$494.081
RI$502.911
SC$460.831
SD$481.011
TN$451.031
TX$456.89–$509.868
UT$467.271
VA$480.07–$562.322
VI$494.081
VT$479.791
WA$507.58–$575.362
WI$465.481
WV$449.161
WY$486.681

See 45381 in every payment locality

How the 45381 rate is calculated

Each of 45381’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 · 45381

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.47

3.47 RVUs× 1.000 GPCI

Practice expense10.79

10.79 RVUs× 1.000 GPCI

Malpractice0.42

0.42 RVUs× 1.000 GPCI

Adjusted RVUs

14.6800

Conversion factor

$33.4009

Medicare rate

$490.33

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,517

Code
45381
Physician work
3.47
Practice expense
10.79
Malpractice
0.42

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 45381 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.47× 1.0003.4700
Practice expense10.79× 0.93310.0671
Malpractice0.42× 0.6390.2684
Total RVUs13.8055
Conversion factor× 33.4009

Office rate, North Carolina$461.11

Office: (3.47 × 1 + 10.79 × 0.933 + 0.42 × 0.639) × $33.4009 = $461.11

Facility: (3.47 × 1 + 1.43 × 0.933 + 0.42 × 0.639) × $33.4009 = $169.43

Open 45381 in the RVU calculator

Payment rules and modifiers for 45381

The CMS indicators that decide how 45381 is paid alongside other services.

CMS payment indicators · 45381

Colonoscopy injection, directed submucosal injection

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

45381 without 51 · national office

$490.33

Colonoscopy injection, directed submucosal injection

45381-51 · Second procedure: 50%

$245.17

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 45381

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

Codes related to 45381
CodeHow it relatesOffice range, North Carolina
Used instead
45378Colonoscopy, diagnostic, no tissue removalDiagnostic colonoscopy when no directed submucosal injection is performed.$355.86
45380Colonoscopy with biopsy, single or multiple forceps biopsiesColonoscopy with biopsy when tissue sampling, rather than injection, is performed.$451.45
45382Colonoscopy, control of bleedingUse when the endoscopic intervention is directed at controlling hemorrhage.$686.47
45390Colonoscopy, mucosal lesion resectionEndoscopic mucosal resection includes submucosal injection when performed as part of the resection.No office rate

How 45381 has changed in North Carolina

45381 · Office / nonfacility

$461.11

Effective 2026-10-01

The base rate is $65.07 higher than on 2025-10-01, moving from $396.04 to $461.11 (16.4%).

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

    $396.04changed to$461.11

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.56 changed to 3.47
    • Practice expense RVU 9.04 changed to 10.79
    • Malpractice RVU 0.47 changed to 0.42
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $413.68changed to$396.04

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.26 changed to 9.04
    • Malpractice RVU 0.44 changed to 0.47

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $406.92changed to$413.68

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $424.22changed to$406.92

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.32 changed to 9.26
    • Malpractice RVU 0.43 changed to 0.44
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $443.12changed to$424.22

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.60 changed to 9.32
    • Malpractice RVU 0.41 changed to 0.43
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $439.31changed to$443.12

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.36 changed to 9.60
    • Malpractice RVU 0.42 changed to 0.41

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $410.54changed to$439.31

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.07 changed to 9.36
    • Malpractice RVU 0.41 changed to 0.42
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $391.38changed to$410.54

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.49 changed to 8.07
    • Malpractice RVU 0.47 changed to 0.41
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $375.11changed to$391.38

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.01 changed to 7.49
    • Malpractice RVU 0.48 changed to 0.47

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $372.66changed to$375.11

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.96 changed to 7.01
    • Malpractice RVU 0.47 changed to 0.48
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $432.60changed to$372.66

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.66 changed to 3.56
    • Practice expense RVU 8.66 changed to 6.96
    • Malpractice RVU 0.48 changed to 0.47
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $449.39changed to$432.60

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 4.19 changed to 3.66
    • Practice expense RVU 8.43 changed to 8.66
    • Malpractice RVU 0.62 changed to 0.48

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $447.15changed to$449.39

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $445.04changed to$447.15

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.39 changed to 8.43
    • Malpractice RVU 0.60 changed to 0.62
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $462.44changed to$445.04

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.67 changed to 8.39
    • Malpractice RVU 0.63 changed to 0.60
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $462.44

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$461.11$169.43RVU26D
2026-07-01$461.11$169.43RVU26C
2026-04-01$461.11$169.43RVU26B
2026-01-01$461.11$169.43RVU26A
2025-10-01$396.04$183.07RVU25D
2025-07-01$396.04$183.07RVU25C
2025-04-01$396.04$183.07RVU25B
2025-01-01$396.04$183.07RVU25A
2024-10-01$413.68$187.12RVU24D
2024-07-01$413.68$187.12RVU24C
2024-04-01$413.68$187.12RVU24B
2024-03-09$413.68$187.12RVU24AR
2024-01-01$406.92$184.06RVU24A
2023-10-01$424.22$190.82RVU23D
2023-07-01$424.22$190.82RVU23C
2023-04-01$424.22$190.82RVU23B
2023-01-01$424.22$190.82RVU23A
2022-10-01$443.12$195.51RVU22D
2022-07-01$443.12$195.51RVU22C
2022-04-01$443.12$195.51RVU22B
2022-01-01$443.12$195.51RVU22A
2021-10-01$439.31$196.77RVU21D
2021-07-01$439.31$196.77RVU21C
2021-04-01$439.31$196.77RVU21B
2021-01-01$439.31$196.77RVU21A
2020-10-01$410.54$200.77RVU20D
2020-07-01$410.54$200.77RVU20C
2020-04-01$410.54$200.77RVU20B
2020-01-01$410.54$200.77RVU20A
2019-10-01$391.38$201.81RVU19D
2019-07-01$391.38$201.81RVU19C
2019-04-01$391.38$201.81RVU19B
2019-01-01$391.38$201.81RVU19A
2018-10-01$375.11$202.84RVU18D
2018-07-01$375.11$202.84RVU18C
2018-04-01$375.11$202.84RVU18B
2018-01-01$375.11$202.84RVU18AR1
2017-10-01$372.66$202.59RVU17D
2017-07-01$372.66$202.59RVU17C
2017-04-01$372.66$202.59RVU17B
2017-01-01$372.66$202.59RVU17A
2016-10-01$432.60$207.84RVU16D
2016-07-01$432.60$207.84RVU16C
2016-04-01$432.60$207.84RVU16B
2016-01-01$432.60$207.84RVU16A
2015-10-01$449.39$241.19RVU15D
2015-07-01$449.39$241.19RVU15C
2015-04-01$447.15$239.99RVU15B
2015-01-01$447.15$239.99RVU15A
2014-10-01$445.04$239.71RVU14D
2014-07-01$445.04$239.71RVU14C
2014-04-01$445.04$239.71RVU14B
2014-01-01$445.04$239.71RVU14A
2013-10-01$462.44$236.93RVU13D
2013-07-01$462.44$236.93RVU13C
2013-04-01$462.44$236.93RVU13B
2013-01-01$462.44$236.93RVU13AR

Price 45381 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

45381 billing questions

When should this code be chosen instead of a biopsy code?

Use it for directed injection beneath the colonic lining, such as lifting or marking a lesion. Use the biopsy code when tissue sampling is the intervention.

Can it be reported with endoscopic mucosal resection?

The mucosal resection code includes submucosal injection when performed as part of that resection. Do not separately report this code for the same injection.

How many units should be reported for several injections?

Multiple directed injections during one colonoscopy do not create separate units; the code covers injection or injections.

What documentation supports reporting it?

Record the colonic site, why material was injected, and the substance or marking method used. Document whether the injection lifted a lesion or marked its location.

Which modifiers or surgical-assistance services are appropriate?

Modifier 50 is inappropriate for this colon procedure. Medicare does not pay an assistant-at-surgery service for this code, and co-surgeon and team-surgery reporting are not permitted.

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 45381PPRRVU2026_Oct_nonQPP.csv, line 5,517 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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