CPT code 45386: Colonoscopy, balloon dilation2026 Medicare rate & RVUs

Medicare pays $670.36 for 45386 nationally in the office and $187.38 in a hospital or facility. Local office rates run $588.11–$912.53.

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

What 45386 covers

A gastroenterologist or colorectal surgeon uses a flexible colonoscope to locate a narrowed area of the colon and expand it with a balloon passed through the scope. The service is commonly performed in a hospital outpatient endoscopy unit or ambulatory surgery center for a colonic stricture, such as narrowing at a surgical anastomosis or associated with inflammatory disease. The balloon dilation is the defining treatment, rather than biopsy, lesion removal, or another endoscopic intervention.

Choose this code when the service is a colonoscopy with balloon dilation; use the sigmoidoscopy dilation code when the examination is limited to the distal colon. The report should identify the narrowed segment and document the dilation performed. A diagnostic examination of the same colon during the therapeutic session is part of the service. CMS applies endoscopy family pricing when related endoscopies are performed together. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing 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.

Where 45386 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

45386 rates by state

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

How the 45386 rate is calculated

Each of 45386’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.

Payment rules and modifiers for 45386

The CMS indicators that decide how 45386 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

45386 compared with similar codes

How to choose

45340Sigmoidoscopy dilationTransendoscopic balloon

Both describe balloon dilation, but 45340 is performed during flexible sigmoidoscopy. Use 45386 when the service is a colonoscopy.

45378ColonoscopyDiagnostic, no tissue removal

45378 describes a diagnostic colonoscopy without a therapeutic intervention. Balloon dilation during the colonoscopy points to 45386 instead.

45380Colonoscopy with biopsySingle or multiple forceps biopsies

45380 describes colonoscopy with biopsy, not balloon treatment of a narrowing. If both services are performed, account for CMS endoscopy family pricing.

Codes related to 45386

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

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

Open CMS sourceHow we calculate rates