CPT code 45386: Colonoscopy, balloon dilation2026 Medicare rate & RVUs in King County, WA
Report this therapeutic colonoscopy when a flexible colonoscope is used to widen a narrowed colonic segment with an endoscopic balloon.
In King County, WA, Medicare pays $794.75 for 45386 in the office and $202.13 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 King County, WA 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. King County, WA pays $794.75. The RVUs are the same everywhere; the geographic indexes change the dollars.
- King County, WA · this page$794.75
- Rest of Washington · Washington$696.68−$98.07
- Los Angeles, CA · California$767.95−$26.80
- Washington, DC area · District of Columbia$773.48−$21.27
- Miami, FL · Florida$714.67−$80.08
- Chicago, IL · Illinois$692.91−$101.84
- Manhattan, NY · New York$773.14−$21.61
Other areas in Washington first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlaskaAlaska | $759.84 | $245.47 |
| 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 |
| Madera, CACalifornia | $716.77 | $187.43 |
| Merced, CACalifornia | $716.77 | $187.43 |
| Modesto, CACalifornia | $716.77 | $187.43 |
| Napa, CACalifornia | $840.28 | $203.72 |
| Oxnard, CACalifornia | $765.22 | $194.34 |
| Redding, CACalifornia | $716.77 | $187.43 |
| Rest of CaliforniaCalifornia | $716.77 | $187.43 |
| Riverside, CACalifornia | $721.55 | $192.21 |
| Sacramento, CACalifornia | $754.80 | $193.10 |
| Salinas, CACalifornia | $752.05 | $192.28 |
| San Diego, CACalifornia | $771.73 | $194.09 |
| Marin County, CACalifornia | $892.51 | $211.51 |
| San Francisco, CACalifornia | $892.01 | $211.01 |
| San Benito County, CACalifornia | $912.53 | $216.08 |
| Santa Clara County, CACalifornia | $910.49 | $214.03 |
| San Luis Obispo, CACalifornia | $739.68 | $189.57 |
| Santa Cruz, CACalifornia | $780.66 | $193.84 |
| Santa Maria, CACalifornia | $755.41 | $192.26 |
| Santa Rosa, CACalifornia | $788.69 | $195.59 |
| Stockton, CACalifornia | $716.77 | $187.43 |
| Vallejo, CACalifornia | $839.56 | $203.00 |
| Visalia, CACalifornia | $716.77 | $187.43 |
| Yuba City, CACalifornia | $716.77 | $187.43 |
| ColoradoColorado | $702.71 | $188.82 |
| ConnecticutConnecticut | $716.92 | $196.76 |
| DelawareDelaware | $663.09 | $185.91 |
| Fort Lauderdale, FLFlorida | $689.16 | $199.90 |
| Rest of FloridaFlorida | $654.31 | $192.58 |
| Atlanta, GAGeorgia | $682.20 | $191.50 |
| Rest of GeorgiaGeorgia | $615.64 | $184.83 |
| Hawaii, Guam, HIHawaii | $737.15 | $188.01 |
| IowaIowa | $616.21 | $174.29 |
| IdahoIdaho | $619.99 | $175.65 |
| East St. Louis, ILIllinois | $642.64 | $198.30 |
| Rest of IllinoisIllinois | $632.28 | $191.32 |
| Suburban Chicago, ILIllinois | $696.95 | $200.93 |
| IndianaIndiana | $623.91 | $176.19 |
| KansasKansas | $611.92 | $175.31 |
| KentuckyKentucky | $609.97 | $180.61 |
| New Orleans, LALouisiana | $640.92 | $186.44 |
| Rest of LouisianaLouisiana | $608.47 | $181.04 |
| Metropolitan Boston, MAMassachusetts | $777.13 | $200.46 |
| Rest of MassachusettsMassachusetts | $697.57 | $189.00 |
| Baltimore area, MDMaryland | $714.70 | $196.46 |
| Rest of MarylandMaryland | $676.77 | $188.00 |
| Rest of MaineMaine | $622.18 | $177.84 |
| Southern Maine, MEMaine | $660.14 | $181.51 |
| Detroit, MIMichigan | $661.79 | $195.72 |
| Rest of MichiganMichigan | $625.90 | $184.95 |
| MinnesotaMinnesota | $675.46 | $178.48 |
| Metropolitan Kansas City, MOMissouri | $637.52 | $184.01 |
| Metropolitan St. Louis, MOMissouri | $644.81 | $185.02 |
| Rest of MissouriMissouri | $596.46 | $180.13 |
| MississippiMississippi | $592.47 | $176.63 |
| MontanaMontana | $670.33 | $187.35 |
| North CarolinaNorth Carolina | $629.36 | $178.74 |
| North DakotaNorth Dakota | $661.63 | $178.65 |
| NebraskaNebraska | $620.19 | $174.41 |
| New HampshireNew Hampshire | $690.36 | $187.58 |
| Northern New JerseyNew Jersey | $764.34 | $204.08 |
| Rest of New JerseyNew Jersey | $725.71 | $198.30 |
| New MexicoNew Mexico | $629.09 | $186.20 |
| NevadaNevada | $668.43 | $184.97 |
| NYC suburbs and Long Island, NYNew York | $791.51 | $217.25 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $729.58 | $200.72 |
| Queens, NYNew York | $781.68 | $210.80 |
| Rest of New YorkNew York | $639.35 | $180.53 |
| OhioOhio | $624.12 | $183.17 |
| OklahomaOklahoma | $610.08 | $178.78 |
| Portland, OROregon | $727.70 | $191.11 |
| Rest of OregonOregon | $663.86 | $182.82 |
| Metropolitan Philadelphia, PAPennsylvania | $697.25 | $194.47 |
| Rest of PennsylvaniaPennsylvania | $625.86 | $182.49 |
| Puerto RicoPuerto Rico | $676.00 | $187.71 |
| Rhode IslandRhode Island | $688.68 | $189.77 |
| South CarolinaSouth Carolina | $627.66 | $181.39 |
| South DakotaSouth Dakota | $660.60 | $177.62 |
| TennesseeTennessee | $615.07 | $176.05 |
| Austin, TXTexas | $699.83 | $188.84 |
| Beaumont, TXTexas | $621.37 | $181.86 |
| Brazoria, TXTexas | $663.31 | $184.68 |
| Dallas, TXTexas | $667.24 | $186.20 |
| Fort Worth, TXTexas | $662.11 | $185.89 |
| Galveston, TXTexas | $665.08 | $185.49 |
| Houston, TXTexas | $673.14 | $193.54 |
| Rest of TexasTexas | $641.76 | $183.42 |
| UtahUtah | $636.89 | $182.89 |
| VirginiaVirginia | $656.98 | $182.21 |
| Virgin Islands, VIUnited States Virgin Islands | $676.00 | $187.71 |
| VermontVermont | $657.77 | $179.62 |
| WisconsinWisconsin | $637.81 | $175.12 |
| West VirginiaWest Virginia | $606.90 | $187.19 |
| WyomingWyoming | $666.54 | $183.56 |
45386 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $759.84 | 1 |
| AL | $597.38 | 1 |
| AR | $588.11 | 1 |
| AZ | $651.72 | 1 |
| CA | $716.77–$912.53 | 29 |
| CO | $702.71 | 1 |
| CT | $716.92 | 1 |
| DC | $773.48 | 1 |
| DE | $663.09 | 1 |
| FL | $654.31–$714.67 | 3 |
| GA | $615.64–$682.20 | 2 |
| GU | $737.15 | 1 |
| HI | $737.15 | 1 |
| IA | $616.21 | 1 |
| ID | $619.99 | 1 |
| IL | $632.28–$696.95 | 4 |
| IN | $623.91 | 1 |
| KS | $611.92 | 1 |
| KY | $609.97 | 1 |
| LA | $608.47–$640.92 | 2 |
| MA | $697.57–$777.13 | 2 |
| MD | $676.77–$773.48 | 3 |
| ME | $622.18–$660.14 | 2 |
| MI | $625.90–$661.79 | 2 |
| MN | $675.46 | 1 |
| MO | $596.46–$644.81 | 3 |
| MS | $592.47 | 1 |
| MT | $670.33 | 1 |
| NC | $629.36 | 1 |
| ND | $661.63 | 1 |
| NE | $620.19 | 1 |
| NH | $690.36 | 1 |
| NJ | $725.71–$764.34 | 2 |
| NM | $629.09 | 1 |
| NV | $668.43 | 1 |
| NY | $639.35–$791.51 | 5 |
| OH | $624.12 | 1 |
| OK | $610.08 | 1 |
| OR | $663.86–$727.70 | 2 |
| PA | $625.86–$697.25 | 2 |
| PR | $676.00 | 1 |
| RI | $688.68 | 1 |
| SC | $627.66 | 1 |
| SD | $660.60 | 1 |
| TN | $615.07 | 1 |
| TX | $621.37–$699.83 | 8 |
| UT | $636.89 | 1 |
| VA | $656.98–$773.48 | 2 |
| VI | $676.00 | 1 |
| VT | $657.77 | 1 |
| WA | $696.68–$794.75 | 2 |
| WI | $637.81 | 1 |
| WV | $606.90 | 1 |
| WY | $666.54 | 1 |
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
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 King County, WA 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
108
- Locality
- King County, WA
- Physician work
- 1.050
- Practice expense
- 1.227
- Malpractice
- 0.817
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.68 | × 1.050 | 3.8640 |
| Practice expense | 15.95 | × 1.227 | 19.5707 |
| Malpractice | 0.44 | × 0.817 | 0.3595 |
| Total RVUs | 23.7941 | ||
| Conversion factor | × 33.4009 | ||
Office rate, King County, WA$794.75
Office: (3.68 × 1.05 + 15.95 × 1.227 + 0.44 × 0.817) × $33.4009 = $794.75
Facility: (3.68 × 1.05 + 1.49 × 1.227 + 0.44 × 0.817) × $33.4009 = $202.13
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
| 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
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%).
How 45386 has changed in King County, WA
45386 · Office / nonfacility
$794.75
Effective 2026-10-01
The base rate is $121.81 higher than on 2025-10-01, moving from $672.94 to $794.75 (18.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$672.94changed to$794.75
- 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
- Work GPCI 1.043 changed to 1.050
- Practice expense GPCI 1.220 changed to 1.227
- Malpractice GPCI 0.853 changed to 0.817
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$711.04changed to$672.94
- 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.
March 9, 2024
RVU24AR
$699.43changed to$711.04
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$724.48changed to$699.43
- 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
- Work GPCI 1.039 changed to 1.043
- Practice expense GPCI 1.207 changed to 1.220
- Malpractice GPCI 0.815 changed to 0.853
January 1, 2023
RVU23A
$753.97changed to$724.48
- 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
- Work GPCI 1.036 changed to 1.039
- Practice expense GPCI 1.194 changed to 1.207
- Malpractice GPCI 0.776 changed to 0.815
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$763.82changed to$753.97
- 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.
January 1, 2021
RVU21A
$711.20changed to$763.82
- 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
- Work GPCI 1.031 changed to 1.036
- Practice expense GPCI 1.170 changed to 1.194
- Malpractice GPCI 0.854 changed to 0.776
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$681.99changed to$711.20
- 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
- Work GPCI 1.027 changed to 1.031
- Practice expense GPCI 1.146 changed to 1.170
- Malpractice GPCI 0.931 changed to 0.854
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$668.38changed to$681.99
- 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.
January 1, 2018
RVU18AR1
$660.47changed to$668.38
- 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
- Work GPCI 1.026 changed to 1.027
- Practice expense GPCI 1.151 changed to 1.146
- Malpractice GPCI 0.713 changed to 0.931
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$738.17changed to$660.47
- 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
- Work GPCI 1.025 changed to 1.026
- Practice expense GPCI 1.155 changed to 1.151
- Malpractice GPCI 0.495 changed to 0.713
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$748.95changed to$738.17
- 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.
July 1, 2015
RVU15C
$745.22changed to$748.95
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$745.49changed to$745.22
- 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 1.150 changed to 1.155
- Malpractice GPCI 0.688 changed to 0.495
Held through RVU15B.
January 1, 2014
RVU14A
$792.03changed to$745.49
- 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 1.144 changed to 1.150
- Malpractice GPCI 0.881 changed to 0.688
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $792.03
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $794.75 | $202.13 | RVU26D |
| 2026-07-01 | $794.75 | $202.13 | RVU26C |
| 2026-04-01 | $794.75 | $202.13 | RVU26B |
| 2026-01-01 | $794.75 | $202.13 | RVU26A |
| 2025-10-01 | $672.94 | $220.70 | RVU25D |
| 2025-07-01 | $672.94 | $220.70 | RVU25C |
| 2025-04-01 | $672.94 | $220.70 | RVU25B |
| 2025-01-01 | $672.94 | $220.70 | RVU25A |
| 2024-10-01 | $711.04 | $225.74 | RVU24D |
| 2024-07-01 | $711.04 | $225.74 | RVU24C |
| 2024-04-01 | $711.04 | $225.74 | RVU24B |
| 2024-03-09 | $711.04 | $225.74 | RVU24AR |
| 2024-01-01 | $699.43 | $222.06 | RVU24A |
| 2023-10-01 | $724.48 | $226.29 | RVU23D |
| 2023-07-01 | $724.48 | $226.29 | RVU23C |
| 2023-04-01 | $724.48 | $226.29 | RVU23B |
| 2023-01-01 | $724.48 | $226.29 | RVU23A |
| 2022-10-01 | $753.97 | $228.38 | RVU22D |
| 2022-07-01 | $753.97 | $228.38 | RVU22C |
| 2022-04-01 | $753.97 | $228.38 | RVU22B |
| 2022-01-01 | $753.97 | $228.38 | RVU22A |
| 2021-10-01 | $763.82 | $229.29 | RVU21D |
| 2021-07-01 | $763.82 | $229.29 | RVU21C |
| 2021-04-01 | $763.82 | $229.29 | RVU21B |
| 2021-01-01 | $763.82 | $229.29 | RVU21A |
| 2020-10-01 | $711.20 | $234.06 | RVU20D |
| 2020-07-01 | $711.20 | $234.06 | RVU20C |
| 2020-04-01 | $711.20 | $234.06 | RVU20B |
| 2020-01-01 | $711.20 | $234.06 | RVU20A |
| 2019-10-01 | $681.99 | $235.95 | RVU19D |
| 2019-07-01 | $681.99 | $235.95 | RVU19C |
| 2019-04-01 | $681.99 | $235.95 | RVU19B |
| 2019-01-01 | $681.99 | $235.95 | RVU19A |
| 2018-10-01 | $668.38 | $236.85 | RVU18D |
| 2018-07-01 | $668.38 | $236.85 | RVU18C |
| 2018-04-01 | $668.38 | $236.85 | RVU18B |
| 2018-01-01 | $668.38 | $236.85 | RVU18AR1 |
| 2017-10-01 | $660.47 | $232.10 | RVU17D |
| 2017-07-01 | $660.47 | $232.10 | RVU17C |
| 2017-04-01 | $660.47 | $232.10 | RVU17B |
| 2017-01-01 | $660.47 | $232.10 | RVU17A |
| 2016-10-01 | $738.17 | $232.83 | RVU16D |
| 2016-07-01 | $738.17 | $232.83 | RVU16C |
| 2016-04-01 | $738.17 | $232.83 | RVU16B |
| 2016-01-01 | $738.17 | $232.83 | RVU16A |
| 2015-10-01 | $748.95 | $277.47 | RVU15D |
| 2015-07-01 | $748.95 | $277.47 | RVU15C |
| 2015-04-01 | $745.22 | $276.09 | RVU15B |
| 2015-01-01 | $745.22 | $276.09 | RVU15A |
| 2014-10-01 | $745.49 | $281.21 | RVU14D |
| 2014-07-01 | $745.49 | $281.21 | RVU14C |
| 2014-04-01 | $745.49 | $281.21 | RVU14B |
| 2014-01-01 | $745.49 | $281.21 | RVU14A |
| 2013-10-01 | $792.03 | $284.49 | RVU13D |
| 2013-07-01 | $792.03 | $284.49 | RVU13C |
| 2013-04-01 | $792.03 | $284.49 | RVU13B |
| 2013-01-01 | $792.03 | $284.49 | RVU13AR |
Where the King County, WA rate applies
King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.
- Seattle
- Algona
- Ames Lake
- 45386 in Auburn · multiple payment areas
- Baring
- Beaux Arts Village
- Bellevue
- Black Diamond
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
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