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CPT code 45398: Colonoscopy, with band ligation2026 Medicare rate & RVUs in North Carolina

Reports colonoscopy with endoscopic band ligation of hemorrhoids when the intervention is performed during examination of the colon.

CMS RVU26DEffective Oct 1, 2026One payment locality4.6K Medicare services in 2024

In North Carolina, Medicare pays $845.31 for 45398 in the office and $198.68 when it’s performed in a hospital or facility.

$845.31Office (non-facility)
$198.68Hospital or facility
−6.3%vs the national office rate ($902.49)

Check a contract rate as a % of Medicare · 45398 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 45398 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 45398 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 45398 covers

A gastroenterologist, colorectal surgeon, or other qualified endoscopist performs a colonoscopy and places bands endoscopically to treat hemorrhoidal tissue, commonly internal hemorrhoids. The colonoscope is used to reach and treat the target during the same procedure; this is distinct from band ligation performed through a sigmoidoscope, which examines a shorter portion of the bowel.

Report this code when the colonoscopy includes hemorrhoid band ligation, and document the examination, hemorrhoid treatment, and procedure performed. A diagnostic inspection during the same session is part of the therapeutic colonoscopy rather than a separate diagnostic colonoscopy claim. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service; 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.

How North Carolina compares for 45398

Across 109 of 109 payment localities, the office rate for 45398 runs from $787.66 in Arkansas to $1,237.77 in San Benito County, CA. North Carolina pays $845.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

45398 in North Carolina vs other payment areas
  1. North Carolina · this page$845.31
  2. Los Angeles, CA · California$1,037.80+$192.49
  3. Washington, DC area · District of Columbia$1,044.85+$199.54
  4. Miami, FL · Florida$963.70+$118.39
  5. Chicago, IL · Illinois$933.13+$87.82
  6. Manhattan, NY · New York$1,043.77+$198.46
  7. Alaska · Alaska$1,010.42+$165.11

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

Every other payment area

45398 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$800.61$194.17
ArkansasArkansas$787.66$192.31
ArizonaArizona$876.50$204.91
Bakersfield, CACalifornia$968.83$209.22
Chico, CACalifornia$967.09$207.49
El Centro, CACalifornia$967.19$207.59
Fresno, CACalifornia$967.09$207.49
Hanford, CACalifornia$967.09$207.49

45398 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.

$787.66

$1,102.43

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

View every state and territory as a table
45398 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,010.421
AL$800.611
AR$787.661
AZ$876.501
CA$967.09–$1,237.7729
CO$947.461
CT$966.841
DC$1,044.851
DE$892.211
FL$879.77–$963.703
GA$825.83–$918.862
GU$996.191
HI$996.191
IA$827.041
ID$832.291
IL$848.92–$939.054
IN$837.771
KS$820.981
KY$818.041
LA$815.92–$861.232
MA$940.13–$1,050.532
MD$911.16–$1,044.853
ME$835.28–$888.392
MI$840.22–$890.152
MN$910.001
MO$799.09–$866.753
MS$793.641
MT$902.451
NC$845.311
ND$890.591
NE$832.621
NH$930.551
NJ$978.50–$1,031.762
NM$844.641
NV$899.891
NY$859.26–$1,069.335
OH$837.791
OK$818.251
OR$893.56–$982.302
PA$840.26–$939.392
PR$910.391
RI$927.531
SC$842.831
SD$889.191
TN$825.371
TX$833.97–$943.728
UT$855.721
VA$883.93–$1,044.852
VI$910.391
VT$885.141
WA$938.99–$1,074.902
WI$857.311
WV$813.471
WY$897.281

See 45398 in every payment locality

How the 45398 rate is calculated

Each of 45398’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 · 45398

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.10

4.10 RVUs× 1.000 GPCI

Practice expense22.32

22.32 RVUs× 1.000 GPCI

Malpractice0.60

0.60 RVUs× 1.000 GPCI

Adjusted RVUs

27.0200

Conversion factor

$33.4009

Medicare rate

$902.49

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,530

Code
45398
Physician work
4.10
Practice expense
22.32
Malpractice
0.60

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 45398 in North Carolina
ComponentRVULocality factorAdjusted
Physician work4.10× 1.0004.1000
Practice expense22.32× 0.93320.8246
Malpractice0.60× 0.6390.3834
Total RVUs25.3080
Conversion factor× 33.4009

Office rate, North Carolina$845.31

Office: (4.1 × 1 + 22.32 × 0.933 + 0.6 × 0.639) × $33.4009 = $845.31

Facility: (4.1 × 1 + 1.57 × 0.933 + 0.6 × 0.639) × $33.4009 = $198.68

Open 45398 in the RVU calculator

Payment rules and modifiers for 45398

The CMS indicators that decide how 45398 is paid alongside other services.

CMS payment indicators · 45398

Colonoscopy, with band ligation

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

45398 without 51 · national office

$902.49

Colonoscopy, with band ligation

45398-51 · Second procedure: 50%

$451.25

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 45398

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

Codes related to 45398
CodeHow it relatesOffice range, North Carolina
Used instead
45350Sigmoidoscopy, endoscopic band ligationBand ligation performed with a sigmoidoscope rather than a colonoscope.$695.30
45378Colonoscopy, diagnostic, no tissue removalDiagnostic colonoscopy when no therapeutic band ligation is performed.$355.86
45382Colonoscopy, control of bleedingColonoscopy with endoscopic control of bleeding rather than hemorrhoid band ligation.$686.47
45380Colonoscopy with biopsy, single or multiple forceps biopsiesColonoscopy with biopsy when tissue sampling, rather than band ligation, is the intervention.$451.45

How 45398 has changed in North Carolina

45398 · Office / nonfacility

$845.31

Effective 2026-10-01

The base rate is $129.49 higher than on 2025-10-01, moving from $715.82 to $845.31 (18.1%).

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

    $715.82changed to$845.31

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.20 changed to 4.10
    • Practice expense RVU 18.91 changed to 22.32
    • Malpractice RVU 0.63 changed to 0.60
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $760.68changed to$715.82

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 19.69 changed to 18.91

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $748.27changed to$760.68

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $790.14changed to$748.27

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 20.11 changed to 19.69
    • Malpractice RVU 0.64 changed to 0.63
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $834.83changed to$790.14

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 20.94 changed to 20.11
    • Malpractice RVU 0.60 changed to 0.64
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $825.28changed to$834.83

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 20.44 changed to 20.94
    • Malpractice RVU 0.59 changed to 0.60

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $757.55changed to$825.28

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 17.55 changed to 20.44
    • Malpractice RVU 0.62 changed to 0.59
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $704.98changed to$757.55

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 16.00 changed to 17.55
    • Malpractice RVU 0.67 changed to 0.62
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $658.30changed to$704.98

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 14.63 changed to 16.00

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $644.17changed to$658.30

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 14.32 changed to 14.63
    • Malpractice RVU 0.57 changed to 0.67
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $699.21changed to$644.17

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.30 changed to 4.20
    • Practice expense RVU 15.83 changed to 14.32
    • Malpractice RVU 0.66 changed to 0.57
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    No ratechanged to$699.21

    Held through RVU16B, RVU16C, RVU16D.

  13. January 1, 2015

    RVU15A

    No ratechanged toNo rate

    Held through RVU15B, RVU15C, RVU15D.

  14. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$845.31$198.68RVU26D
2026-07-01$845.31$198.68RVU26C
2026-04-01$845.31$198.68RVU26B
2026-01-01$845.31$198.68RVU26A
2025-10-01$715.82$213.51RVU25D
2025-07-01$715.82$213.51RVU25C
2025-04-01$715.82$213.51RVU25B
2025-01-01$715.82$213.51RVU25A
2024-10-01$760.68$219.10RVU24D
2024-07-01$760.68$219.10RVU24C
2024-04-01$760.68$219.10RVU24B
2024-03-09$760.68$219.10RVU24AR
2024-01-01$748.27$215.52RVU24A
2023-10-01$790.14$224.07RVU23D
2023-07-01$790.14$224.07RVU23C
2023-04-01$790.14$224.07RVU23B
2023-01-01$790.14$224.07RVU23A
2022-10-01$834.83$229.47RVU22D
2022-07-01$834.83$229.47RVU22C
2022-04-01$834.83$229.47RVU22B
2022-01-01$834.83$229.47RVU22A
2021-10-01$825.28$230.12RVU21D
2021-07-01$825.28$230.12RVU21C
2021-04-01$825.28$230.12RVU21B
2021-01-01$825.28$230.12RVU21A
2020-10-01$757.55$235.98RVU20D
2020-07-01$757.55$235.98RVU20C
2020-04-01$757.55$235.98RVU20B
2020-01-01$757.55$235.98RVU20A
2019-10-01$704.98$235.59RVU19D
2019-07-01$704.98$235.59RVU19C
2019-04-01$704.98$235.59RVU19B
2019-01-01$704.98$235.59RVU19A
2018-10-01$658.30$236.00RVU18D
2018-07-01$658.30$236.00RVU18C
2018-04-01$658.30$236.00RVU18B
2018-01-01$658.30$236.00RVU18AR1
2017-10-01$644.17$236.88RVU17D
2017-07-01$644.17$236.88RVU17C
2017-04-01$644.17$236.88RVU17B
2017-01-01$644.17$236.88RVU17A
2016-10-01$699.21$242.03RVU16D
2016-07-01$699.21$242.03RVU16C
2016-04-01$699.21$242.03RVU16B
2016-01-01$699.21$242.03RVU16A
2015-10-01Separate payment rules applySeparate payment rules applyRVU15D
2015-07-01Separate payment rules applySeparate payment rules applyRVU15C
2015-04-01Separate payment rules applySeparate payment rules applyRVU15B
2015-01-01Separate payment rules applySeparate payment rules applyRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 45398 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

45398 billing questions

When should 45398 be selected instead of 45350?

Use 45398 when the band ligation is performed during colonoscopy. Use 45350 when the procedure is performed with a sigmoidoscope rather than a colonoscope.

Can the diagnostic colonoscopy be reported separately?

Do not separately report a diagnostic colonoscopy for the inspection that is part of the same therapeutic colonoscopy with band ligation.

How are related endoscopies handled in the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. Document the procedures performed during the session.

Should modifier 50 be appended for multiple hemorrhoids?

No. CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

Can an assistant, co-surgeon, or surgical team be billed?

CMS does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

What does the 0-day global period include?

Same-day preoperative and postoperative care is included in the procedure.

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 45398PPRRVU2026_Oct_nonQPP.csv, line 5,530 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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