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

Report this therapeutic colonoscopy when a flexible colonoscope is used to widen a narrowed colonic segment with an endoscopic balloon.

CMS RVU26DEffective Oct 1, 2026One payment locality2.3K Medicare services in 2024

In Ohio, Medicare pays $624.12 for 45386 in the office and $183.17 when it’s performed in a hospital or facility.

$624.12Office (non-facility)
$183.17Hospital or facility
−6.9%vs the national office rate ($670.36)

Check a contract rate as a % of Medicare · 45386 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 45386 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Ohio
  2. What 45386 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 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.

How Ohio compares for 45386

Across 109 of 109 payment localities, the office rate for 45386 runs from $588.11 in Arkansas to $912.53 in San Benito County, CA. Ohio pays $624.12. The RVUs are the same everywhere; the geographic indexes change the dollars.

45386 in Ohio vs other payment areas
  1. Ohio · this page$624.12
  2. Los Angeles, CA · California$767.95+$143.83
  3. Washington, DC area · District of Columbia$773.48+$149.36
  4. Miami, FL · Florida$714.67+$90.55
  5. Chicago, IL · Illinois$692.91+$68.79
  6. Manhattan, NY · New York$773.14+$149.02
  7. Alaska · Alaska$759.84+$135.72

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

Every other payment area

45386 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$597.38$174.78
ArkansasArkansas$588.11$173.23
ArizonaArizona$651.72$183.72
Bakersfield, CACalifornia$718.09$188.75
Chico, CACalifornia$716.77$187.43
El Centro, CACalifornia$716.84$187.50
Fresno, CACalifornia$716.77$187.43
Hanford, CACalifornia$716.77$187.43

45386 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.

$588.11

$814.65

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

View every state and territory as a table
45386 office rate range by state
State / territoryOffice rate rangeLocalities
AK$759.841
AL$597.381
AR$588.111
AZ$651.721
CA$716.77–$912.5329
CO$702.711
CT$716.921
DC$773.481
DE$663.091
FL$654.31–$714.673
GA$615.64–$682.202
GU$737.151
HI$737.151
IA$616.211
ID$619.991
IL$632.28–$696.954
IN$623.911
KS$611.921
KY$609.971
LA$608.47–$640.922
MA$697.57–$777.132
MD$676.77–$773.483
ME$622.18–$660.142
MI$625.90–$661.792
MN$675.461
MO$596.46–$644.813
MS$592.471
MT$670.331
NC$629.361
ND$661.631
NE$620.191
NH$690.361
NJ$725.71–$764.342
NM$629.091
NV$668.431
NY$639.35–$791.515
OH$624.121
OK$610.081
OR$663.86–$727.702
PA$625.86–$697.252
PR$676.001
RI$688.681
SC$627.661
SD$660.601
TN$615.071
TX$621.37–$699.838
UT$636.891
VA$656.98–$773.482
VI$676.001
VT$657.771
WA$696.68–$794.752
WI$637.811
WV$606.901
WY$666.541

See 45386 in every payment locality

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.

How the rate is built · 45386

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.68

3.68 RVUs× 1.000 GPCI

Practice expense15.95

15.95 RVUs× 1.000 GPCI

Malpractice0.44

0.44 RVUs× 1.000 GPCI

Adjusted RVUs

20.0700

Conversion factor

$33.4009

Medicare rate

$670.36

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

The exact Ohio inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,521

Code
45386
Physician work
3.68
Practice expense
15.95
Malpractice
0.44

GPCI2026.csv

85

Locality
Ohio
Physician work
1.000
Practice expense
0.913
Malpractice
1.008
Office calculation for 45386 in Ohio
ComponentRVULocality factorAdjusted
Physician work3.68× 1.0003.6800
Practice expense15.95× 0.91314.5624
Malpractice0.44× 1.0080.4435
Total RVUs18.6859
Conversion factor× 33.4009

Office rate, Ohio$624.12

Office: (3.68 × 1 + 15.95 × 0.913 + 0.44 × 1.008) × $33.4009 = $624.12

Facility: (3.68 × 1 + 1.49 × 0.913 + 0.44 × 1.008) × $33.4009 = $183.17

Open 45386 in the RVU calculator

Payment rules and modifiers for 45386

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

CMS payment indicators · 45386

Colonoscopy, balloon dilation

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

45386 without 51 · national office

$670.36

Colonoscopy, balloon dilation

45386-51 · Second procedure: 50%

$335.18

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 45386

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

Codes related to 45386
CodeHow it relatesOffice range, Ohio
Used instead
45340Sigmoidoscopy dilation, transendoscopic balloonBalloon dilation during flexible sigmoidoscopy rather than colonoscopy.$467.30
45378Colonoscopy, diagnostic, no tissue removalDiagnostic colonoscopy without the balloon dilation service.$355.75
Often billed with
45380Colonoscopy with biopsy, single or multiple forceps biopsiesA distinct biopsy may accompany dilation; CMS endoscopy family pricing applies when related endoscopies are performed together.$449.63

How 45386 has changed in Ohio

45386 · Office / nonfacility

$624.12

Effective 2026-10-01

The base rate is $88.24 higher than on 2025-10-01, moving from $535.88 to $624.12 (16.5%).

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

    $535.88changed to$624.12

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.77 changed to 3.68
    • Practice expense RVU 13.48 changed to 15.95
    • Malpractice RVU 0.50 changed to 0.44
    • Practice expense GPCI 0.911 changed to 0.913
    • Malpractice GPCI 1.033 changed to 1.008

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $565.03changed to$535.88

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 13.95 changed to 13.48
    • Malpractice RVU 0.48 changed to 0.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $555.81changed to$565.03

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $581.99changed to$555.81

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 14.15 changed to 13.95
    • Malpractice RVU 0.47 changed to 0.48
    • Practice expense GPCI 0.912 changed to 0.911
    • Malpractice GPCI 1.063 changed to 1.033

  5. January 1, 2023

    RVU23A

    $611.26changed to$581.99

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 14.69 changed to 14.15
    • Malpractice RVU 0.44 changed to 0.47
    • Practice expense GPCI 0.913 changed to 0.912
    • Malpractice GPCI 1.094 changed to 1.063

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $619.26changed to$611.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 14.77 changed to 14.69
    • Malpractice RVU 0.45 changed to 0.44

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $588.61changed to$619.26

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 13.20 changed to 14.77
    • Malpractice RVU 0.44 changed to 0.45
    • Practice expense GPCI 0.915 changed to 0.913
    • Malpractice GPCI 1.049 changed to 1.094

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $574.71changed to$588.61

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.72 changed to 13.20
    • Malpractice RVU 0.51 changed to 0.44
    • Practice expense GPCI 0.917 changed to 0.915
    • Malpractice GPCI 1.005 changed to 1.049

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $563.88changed to$574.71

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 12.40 changed to 12.72
    • Malpractice RVU 0.52 changed to 0.51

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $559.54changed to$563.88

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.30 changed to 12.40
    • Malpractice RVU 0.53 changed to 0.52
    • Practice expense GPCI 0.918 changed to 0.917
    • Malpractice GPCI 0.999 changed to 1.005

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $624.19changed to$559.54

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.87 changed to 3.77
    • Practice expense RVU 14.18 changed to 12.30
    • Malpractice RVU 0.55 changed to 0.53
    • Malpractice GPCI 0.993 changed to 0.999

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $640.78changed to$624.19

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 4.57 changed to 3.87
    • Practice expense RVU 13.69 changed to 14.18
    • Malpractice RVU 0.70 changed to 0.55

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $637.60changed to$640.78

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $641.33changed to$637.60

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 13.61 changed to 13.69
    • Malpractice RVU 0.69 changed to 0.70
    • Practice expense GPCI 0.923 changed to 0.918
    • Malpractice GPCI 1.117 changed to 0.993

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $681.03changed to$641.33

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 15.70 changed to 13.61
    • Malpractice RVU 0.72 changed to 0.69
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.240 changed to 1.117

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $681.03

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$624.12$183.17RVU26D
2026-07-01$624.12$183.17RVU26C
2026-04-01$624.12$183.17RVU26B
2026-01-01$624.12$183.17RVU26A
2025-10-01$535.88$198.18RVU25D
2025-07-01$535.88$198.18RVU25C
2025-04-01$535.88$198.18RVU25B
2025-01-01$535.88$198.18RVU25A
2024-10-01$565.03$202.65RVU24D
2024-07-01$565.03$202.65RVU24C
2024-04-01$565.03$202.65RVU24B
2024-03-09$565.03$202.65RVU24AR
2024-01-01$555.81$199.34RVU24A
2023-10-01$581.99$205.57RVU23D
2023-07-01$581.99$205.57RVU23C
2023-04-01$581.99$205.57RVU23B
2023-01-01$581.99$205.57RVU23A
2022-10-01$611.26$209.37RVU22D
2022-07-01$611.26$209.37RVU22C
2022-04-01$611.26$209.37RVU22B
2022-01-01$611.26$209.37RVU22A
2021-10-01$619.26$210.53RVU21D
2021-07-01$619.26$210.53RVU21C
2021-04-01$619.26$210.53RVU21B
2021-01-01$619.26$210.53RVU21A
2020-10-01$588.61$215.46RVU20D
2020-07-01$588.61$215.46RVU20C
2020-04-01$588.61$215.46RVU20B
2020-01-01$588.61$215.46RVU20A
2019-10-01$574.71$217.79RVU19D
2019-07-01$574.71$217.79RVU19C
2019-04-01$574.71$217.79RVU19B
2019-01-01$574.71$217.79RVU19A
2018-10-01$563.88$218.57RVU18D
2018-07-01$563.88$218.57RVU18C
2018-04-01$563.88$218.57RVU18B
2018-01-01$563.88$218.57RVU18AR1
2017-10-01$559.54$217.89RVU17D
2017-07-01$559.54$217.89RVU17C
2017-04-01$559.54$217.89RVU17B
2017-01-01$559.54$217.89RVU17A
2016-10-01$624.19$222.54RVU16D
2016-07-01$624.19$222.54RVU16C
2016-04-01$624.19$222.54RVU16B
2016-01-01$624.19$222.54RVU16A
2015-10-01$640.78$266.05RVU15D
2015-07-01$640.78$266.05RVU15C
2015-04-01$637.60$264.73RVU15B
2015-01-01$637.60$264.73RVU15A
2014-10-01$641.33$268.69RVU14D
2014-07-01$641.33$268.69RVU14C
2014-04-01$641.33$268.69RVU14B
2014-01-01$641.33$268.69RVU14A
2013-10-01$681.03$269.76RVU13D
2013-07-01$681.03$269.76RVU13C
2013-04-01$681.03$269.76RVU13B
2013-01-01$681.03$269.76RVU13AR

Price 45386 for an earlier date of service

Where the Ohio rate applies

Ohio is a Medicare payment area, not a city. Our Census mapping connects it to 1265 cities and communities in Ohio. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Ada
  • Adamsville
  • Addyston
  • Adelphi
  • Adena
  • Ai
  • Akron

Browse all communities in Ohio

45386 billing questions

When should this code be used instead of 45340?

Use this code for balloon dilation performed through a colonoscope. Code 45340 describes balloon dilation during flexible sigmoidoscopy, a more limited examination.

Can 45378 also be reported for the same session?

The diagnostic inspection performed as part of the therapeutic colonoscopy is included. Do not separately report 45378 for that same examination.

What documentation supports reporting balloon dilation?

Document the colonic narrowing and location, the use of an endoscopic balloon, and the dilation performed. The record should make clear that balloon treatment—not another therapeutic technique—was provided.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure. CMS assigns a 0-day global period.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for it; co-surgeons and team surgery are also 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 45386PPRRVU2026_Oct_nonQPP.csv, line 5,521 (RVU26D)
Geographic factors for OhioGPCI2026.csv, line 85 (RVU26D)

Open CMS sourceHow we calculate rates

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