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CPT code 45392: Colonoscopy with EUS, with needle sampling2026 Medicare rate & RVUs

Reports colonoscopy with endoscopic ultrasound-guided needle aspiration or biopsy to sample a lesion within or beyond the bowel wall.

CMS RVU26DEffective Oct 1, 2026109 payment localities111 Medicare services in 2024

Medicare pays $265.87 for 45392 nationally in a facility.

Medicare rate · 45392

Colonoscopy with EUS, with needle sampling

Office or facility?

Work RVUs
5.36
Total RVUs
7.96
Global days
000

National rate · 2026

$265.87

Facility setting, before claim adjustments.

See every locality for 45392 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 45392 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 45392 covers

A gastroenterologist advances a colonoscope and uses endoscopic ultrasound to identify a target in or near the colorectal wall, then guides a needle through the endoscope to obtain a sample. Typical targets include subepithelial lesions or nearby structures such as perirectal lymph nodes. The service may be performed in a hospital or ambulatory endoscopy center, with the needle specimen sent for pathology or cytology review.

Report this code when the colonoscopic EUS examination includes ultrasound-guided intramural or transmural fine needle aspiration or biopsy; documentation should identify the target, ultrasound guidance, needle sampling, and specimen obtained. It is distinct from EUS without needle sampling and from forceps biopsy of the mucosal surface. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing governs payment. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery under the statutory restriction; 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.

Where 45392 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

45392 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$248.72
AlaskaUnavailable$350.56
ArizonaUnavailable$260.88
ArkansasUnavailable$246.62
Atlanta, GAUnavailable$271.57
Austin, TXUnavailable$267.76
Bakersfield, CAUnavailable$267.69
Baltimore area, MDUnavailable$278.42
Beaumont, TXUnavailable$258.44
Brazoria, TXUnavailable$262.22

45392 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
45392 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 45392 rate is calculated

Each of 45392’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 · 45392

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.36

5.36 RVUs× 1.000 GPCI

Practice expense1.99

1.99 RVUs× 1.000 GPCI

Malpractice0.61

0.61 RVUs× 1.000 GPCI

Adjusted RVUs

7.9600

Conversion factor

$33.4009

Medicare rate

$265.87

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

Payment rules and modifiers for 45392

The CMS indicators that decide how 45392 is paid alongside other services.

CMS payment indicators · 45392

Colonoscopy with EUS, with needle sampling

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

45392 without 51 · national facility

$265.87

Colonoscopy with EUS, with needle sampling

45392-51 · Second procedure: 50%

$132.94

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

45392 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 45392

    Colonoscopy with EUS, with needle sampling5.36 wRVU

    Not priced

  • 45391

    Colonoscopy EUS, ultrasound examination only4.52 wRVU

    Not priced

  • 45380

    Colonoscopy with biopsy, single or multiple forceps biopsies3.47 wRVU

    $479.97

  • 43242

    EUS-guided biopsy, intramural or transmural sampling4.61 wRVU

    Not priced

How to choose

45391Colonoscopy EUSUltrasound examination only
45391 describes colonoscopy with EUS but without the needle aspiration or biopsy. Choose 45392 when EUS guides needle sampling of a target.
45380Colonoscopy with biopsySingle or multiple forceps biopsies
45380 is for forceps biopsy of colorectal mucosa. 45392 is for needle sampling guided by endoscopic ultrasound, including targets within or beyond the bowel wall.
43242EUS-guided biopsyIntramural or transmural sampling
Both involve EUS-guided needle sampling, but 43242 is performed through an upper-GI endoscope for an upper-GI target; 45392 uses a colonoscope for a colorectal or nearby target.

Codes related to 45392

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

Codes related to 45392
CodeHow it relatesNational office range
Same family
45391Colonoscopy EUS, ultrasound examination onlyColonoscopy with EUS without the needle aspiration or biopsy included in 45392.No office rate
Used instead
45380Colonoscopy with biopsy, single or multiple forceps biopsiesForceps biopsy of a colorectal mucosal lesion rather than EUS-guided needle sampling.$423.81–$640.93
45378Colonoscopy, diagnostic, no tissue removalDiagnostic colonoscopy without the EUS-guided needle sampling service.$335.05–$497.55
43242EUS-guided biopsy, intramural or transmural samplingEUS-guided needle sampling through an upper gastrointestinal endoscope for an upper-GI target.No office rate

45392 billing questions

How does this differ from 45391?

45392 includes EUS-guided fine needle aspiration or biopsy. Use 45391 for colonoscopy with EUS when needle sampling is not performed.

Can 45380 also be reported for the needle specimen?

The EUS-guided needle sampling is part of 45392, not a separate forceps biopsy. A separately performed mucosal biopsy is a different service and should be supported by distinct documentation.

What documentation supports 45392?

Document the endoscopic ultrasound findings, the target's location, needle guidance, sampling performed, and the specimen obtained. The record should distinguish needle sampling from a surface biopsy.

How are related endoscopies paid when performed together?

CMS endoscopy-family pricing applies when related endoscopies are performed together, so payment follows the family pricing rules rather than treating every related procedure as an independent full service.

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

Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it under the statutory restriction.

Can co-surgeons or a surgical team report this service?

Co-surgeons and team surgery are not permitted for this code under the CMS rules.

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 45392PPRRVU2026_Oct_nonQPP.csv, line 5,526 (RVU26D)

Open CMS sourceHow we calculate rates

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