CPT code 45392: Colonoscopy with EUS, with needle sampling2026 Medicare rate & RVUs in Texas
Reports colonoscopy with endoscopic ultrasound-guided needle aspiration or biopsy to sample a lesion within or beyond the bowel wall.
CMS doesn’t publish an office rate for 45392 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $267.76 |
| Beaumont, TX | Unavailable | $258.44 |
| Brazoria, TX | Unavailable | $262.22 |
| Dallas, TX | Unavailable | $264.32 |
| Fort Worth, TX | Unavailable | $263.92 |
| Galveston, TX | Unavailable | $263.33 |
| Houston, TX | Unavailable | $274.50 |
| Rest of Texas | Unavailable | $260.50 |
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
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
| 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
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%).
45392 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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