CPT code 45398: Colonoscopy, with band ligation2026 Medicare rate & RVUs in Puerto Rico
Reports colonoscopy with endoscopic band ligation of hemorrhoids when the intervention is performed during examination of the colon.
In Puerto Rico, Medicare pays $910.39 for 45398 in the office and $209.70 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Puerto Rico 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. Puerto Rico pays $910.39. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$910.39
- Los Angeles, CA · California$1,037.80+$127.41
- Washington, DC area · District of Columbia$1,044.85+$134.46
- Miami, FL · Florida$963.70+$53.31
- Chicago, IL · Illinois$933.13+$22.74
- Manhattan, NY · New York$1,043.77+$133.38
- Alaska · Alaska$1,010.42+$100.03
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $967.09 | $207.49 |
| Merced, CACalifornia | $967.09 | $207.49 |
| Modesto, CACalifornia | $967.09 | $207.49 |
| Napa, CACalifornia | $1,138.33 | $224.87 |
| Oxnard, CACalifornia | $1,034.45 | $215.25 |
| Redding, CACalifornia | $967.09 | $207.49 |
| Rest of CaliforniaCalifornia | $967.09 | $207.49 |
| Riverside, CACalifornia | $973.58 | $213.98 |
| Sacramento, CACalifornia | $1,019.64 | $213.60 |
| Salinas, CACalifornia | $1,015.97 | $212.71 |
| San Diego, CACalifornia | $1,043.54 | $214.63 |
| Marin County, CACalifornia | $1,210.32 | $233.09 |
| San Francisco, CACalifornia | $1,209.64 | $232.41 |
| San Benito County, CACalifornia | $1,237.77 | $238.37 |
| Santa Clara County, CACalifornia | $1,234.99 | $235.58 |
| San Luis Obispo, CACalifornia | $999.15 | $209.74 |
| Santa Cruz, CACalifornia | $1,056.35 | $214.28 |
| Santa Maria, CACalifornia | $1,020.78 | $212.66 |
| Santa Rosa, CACalifornia | $1,067.28 | $216.19 |
| Stockton, CACalifornia | $967.09 | $207.49 |
| Vallejo, CACalifornia | $1,137.35 | $223.88 |
| Visalia, CACalifornia | $967.09 | $207.49 |
| Yuba City, CACalifornia | $967.09 | $207.49 |
| ColoradoColorado | $947.46 | $210.03 |
| ConnecticutConnecticut | $966.84 | $220.41 |
| DelawareDelaware | $892.21 | $207.45 |
| Fort Lauderdale, FLFlorida | $928.38 | $226.30 |
| Rest of FloridaFlorida | $879.77 | $217.20 |
| Atlanta, GAGeorgia | $918.86 | $214.70 |
| Rest of GeorgiaGeorgia | $825.83 | $207.61 |
| Hawaii, Guam, HIHawaii | $996.19 | $208.17 |
| IowaIowa | $827.04 | $192.88 |
| IdahoIdaho | $832.29 | $194.67 |
| East St. Louis, ILIllinois | $863.17 | $225.55 |
| Rest of IllinoisIllinois | $848.92 | $216.14 |
| Suburban Chicago, ILIllinois | $939.05 | $227.27 |
| IndianaIndiana | $837.77 | $195.29 |
| KansasKansas | $820.98 | $194.45 |
| KentuckyKentucky | $818.04 | $201.90 |
| New Orleans, LALouisiana | $861.23 | $209.06 |
| Rest of LouisianaLouisiana | $815.92 | $202.55 |
| Metropolitan Boston, MAMassachusetts | $1,050.53 | $223.01 |
| Rest of MassachusettsMassachusetts | $940.13 | $210.33 |
| Baltimore area, MDMaryland | $963.86 | $220.19 |
| Rest of MarylandMaryland | $911.16 | $209.78 |
| Rest of MaineMaine | $835.28 | $197.65 |
| Southern Maine, MEMaine | $888.39 | $201.56 |
| Detroit, MIMichigan | $890.15 | $221.34 |
| Rest of MichiganMichigan | $840.22 | $207.45 |
| MinnesotaMinnesota | $910.00 | $196.84 |
| Metropolitan Kansas City, MOMissouri | $856.56 | $205.76 |
| Metropolitan St. Louis, MOMissouri | $866.75 | $206.95 |
| Rest of MissouriMissouri | $799.09 | $201.67 |
| MississippiMississippi | $793.64 | $196.90 |
| MontanaMontana | $902.45 | $209.38 |
| North CarolinaNorth Carolina | $845.31 | $198.68 |
| North DakotaNorth Dakota | $890.59 | $197.52 |
| NebraskaNebraska | $832.62 | $192.92 |
| New HampshireNew Hampshire | $930.55 | $209.07 |
| Northern New JerseyNew Jersey | $1,031.76 | $227.80 |
| Rest of New JerseyNew Jersey | $978.50 | $221.67 |
| New MexicoNew Mexico | $844.64 | $209.10 |
| NevadaNevada | $899.89 | $206.13 |
| NYC suburbs and Long Island, NYNew York | $1,069.33 | $245.27 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $983.69 | $224.78 |
| Queens, NYNew York | $1,055.80 | $236.59 |
| Rest of New YorkNew York | $859.26 | $200.85 |
| OhioOhio | $837.79 | $205.02 |
| OklahomaOklahoma | $818.25 | $199.34 |
| Portland, OROregon | $982.30 | $212.31 |
| Rest of OregonOregon | $893.56 | $203.26 |
| Metropolitan Philadelphia, PAPennsylvania | $939.39 | $217.91 |
| Rest of PennsylvaniaPennsylvania | $840.26 | $204.02 |
| Rhode IslandRhode Island | $927.53 | $211.59 |
| South CarolinaSouth Carolina | $842.83 | $202.43 |
| South DakotaSouth Dakota | $889.19 | $196.12 |
| TennesseeTennessee | $825.37 | $195.37 |
| Austin, TXTexas | $943.72 | $210.45 |
| Beaumont, TXTexas | $833.97 | $203.28 |
| Brazoria, TXTexas | $892.47 | $205.64 |
| Dallas, TXTexas | $897.90 | $207.60 |
| Fort Worth, TXTexas | $890.70 | $207.34 |
| Galveston, TXTexas | $894.92 | $206.71 |
| Houston, TXTexas | $905.90 | $217.69 |
| Rest of TexasTexas | $862.53 | $204.81 |
| UtahUtah | $855.72 | $204.23 |
| VirginiaVirginia | $883.93 | $202.64 |
| Virgin Islands, VIUnited States Virgin Islands | $910.39 | $209.70 |
| VermontVermont | $885.14 | $199.00 |
| Rest of WashingtonWashington | $938.99 | $209.19 |
| King County, WAWashington | $1,074.90 | $224.51 |
| WisconsinWisconsin | $857.31 | $193.35 |
| West VirginiaWest Virginia | $813.47 | $211.19 |
| WyomingWyoming | $897.28 | $204.21 |
45398 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.
$787.66
$1,102.43
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 | $1,010.42 | 1 |
| AL | $800.61 | 1 |
| AR | $787.66 | 1 |
| AZ | $876.50 | 1 |
| CA | $967.09–$1,237.77 | 29 |
| CO | $947.46 | 1 |
| CT | $966.84 | 1 |
| DC | $1,044.85 | 1 |
| DE | $892.21 | 1 |
| FL | $879.77–$963.70 | 3 |
| GA | $825.83–$918.86 | 2 |
| GU | $996.19 | 1 |
| HI | $996.19 | 1 |
| IA | $827.04 | 1 |
| ID | $832.29 | 1 |
| IL | $848.92–$939.05 | 4 |
| IN | $837.77 | 1 |
| KS | $820.98 | 1 |
| KY | $818.04 | 1 |
| LA | $815.92–$861.23 | 2 |
| MA | $940.13–$1,050.53 | 2 |
| MD | $911.16–$1,044.85 | 3 |
| ME | $835.28–$888.39 | 2 |
| MI | $840.22–$890.15 | 2 |
| MN | $910.00 | 1 |
| MO | $799.09–$866.75 | 3 |
| MS | $793.64 | 1 |
| MT | $902.45 | 1 |
| NC | $845.31 | 1 |
| ND | $890.59 | 1 |
| NE | $832.62 | 1 |
| NH | $930.55 | 1 |
| NJ | $978.50–$1,031.76 | 2 |
| NM | $844.64 | 1 |
| NV | $899.89 | 1 |
| NY | $859.26–$1,069.33 | 5 |
| OH | $837.79 | 1 |
| OK | $818.25 | 1 |
| OR | $893.56–$982.30 | 2 |
| PA | $840.26–$939.39 | 2 |
| PR | $910.39 | 1 |
| RI | $927.53 | 1 |
| SC | $842.83 | 1 |
| SD | $889.19 | 1 |
| TN | $825.37 | 1 |
| TX | $833.97–$943.72 | 8 |
| UT | $855.72 | 1 |
| VA | $883.93–$1,044.85 | 2 |
| VI | $910.39 | 1 |
| VT | $885.14 | 1 |
| WA | $938.99–$1,074.90 | 2 |
| WI | $857.31 | 1 |
| WV | $813.47 | 1 |
| WY | $897.28 | 1 |
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
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 Puerto Rico 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
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.10 | × 1.000 | 4.1000 |
| Practice expense | 22.32 | × 1.011 | 22.5655 |
| Malpractice | 0.60 | × 0.985 | 0.5910 |
| Total RVUs | 27.2565 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$910.39
Office: (4.1 × 1 + 22.32 × 1.011 + 0.6 × 0.985) × $33.4009 = $910.39
Facility: (4.1 × 1 + 1.57 × 1.011 + 0.6 × 0.985) × $33.4009 = $209.70
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
| 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
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%).
How 45398 has changed in Puerto Rico
45398 · Office / nonfacility
$910.39
Effective 2026-10-01
The base rate is $138.57 higher than on 2025-10-01, moving from $771.82 to $910.39 (18.0%).
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
$771.82changed to$910.39
- 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 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$820.42changed to$771.82
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 19.69 changed to 18.91
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$807.03changed to$820.42
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$850.59changed to$807.03
- 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 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$845.49changed to$850.59
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$896.27changed to$845.49
- 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 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$885.77changed to$896.27
- 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.
January 1, 2021
RVU21A
$812.12changed to$885.77
- 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
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$755.93changed to$812.12
- 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 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$705.44changed to$755.93
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 14.63 changed to 16.00
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$603.79changed to$705.44
- 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
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$560.46changed to$603.79
- 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 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$560.46
Held through RVU16B, RVU16C, RVU16D.
January 1, 2015
RVU15A
No ratechanged toNo rate
Held through RVU15B, RVU15C, RVU15D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $910.39 | $209.70 | RVU26D |
| 2026-07-01 | $910.39 | $209.70 | RVU26C |
| 2026-04-01 | $910.39 | $209.70 | RVU26B |
| 2026-01-01 | $910.39 | $209.70 | RVU26A |
| 2025-10-01 | $771.82 | $225.57 | RVU25D |
| 2025-07-01 | $771.82 | $225.57 | RVU25C |
| 2025-04-01 | $771.82 | $225.57 | RVU25B |
| 2025-01-01 | $771.82 | $225.57 | RVU25A |
| 2024-10-01 | $820.42 | $231.46 | RVU24D |
| 2024-07-01 | $820.42 | $231.46 | RVU24C |
| 2024-04-01 | $820.42 | $231.46 | RVU24B |
| 2024-03-09 | $820.42 | $231.46 | RVU24AR |
| 2024-01-01 | $807.03 | $227.69 | RVU24A |
| 2023-10-01 | $850.59 | $235.06 | RVU23D |
| 2023-07-01 | $845.49 | $234.84 | RVU23C |
| 2023-04-01 | $845.49 | $234.84 | RVU23B |
| 2023-01-01 | $845.49 | $234.84 | RVU23A |
| 2022-10-01 | $896.27 | $238.72 | RVU22D |
| 2022-07-01 | $896.27 | $238.72 | RVU22C |
| 2022-04-01 | $896.27 | $238.72 | RVU22B |
| 2022-01-01 | $896.27 | $238.72 | RVU22A |
| 2021-10-01 | $885.77 | $239.30 | RVU21D |
| 2021-07-01 | $885.77 | $239.30 | RVU21C |
| 2021-04-01 | $885.77 | $239.30 | RVU21B |
| 2021-01-01 | $885.77 | $239.30 | RVU21A |
| 2020-10-01 | $812.12 | $246.80 | RVU20D |
| 2020-07-01 | $812.12 | $246.80 | RVU20C |
| 2020-04-01 | $812.12 | $246.80 | RVU20B |
| 2020-01-01 | $812.12 | $246.80 | RVU20A |
| 2019-10-01 | $755.93 | $248.21 | RVU19D |
| 2019-07-01 | $755.93 | $248.21 | RVU19C |
| 2019-04-01 | $755.93 | $248.21 | RVU19B |
| 2019-01-01 | $755.93 | $248.21 | RVU19A |
| 2018-10-01 | $705.44 | $248.67 | RVU18D |
| 2018-07-01 | $705.44 | $248.67 | RVU18C |
| 2018-04-01 | $705.44 | $248.67 | RVU18B |
| 2018-01-01 | $705.44 | $248.67 | RVU18AR1 |
| 2017-10-01 | $603.79 | $229.30 | RVU17D |
| 2017-07-01 | $603.79 | $229.30 | RVU17C |
| 2017-04-01 | $603.79 | $229.30 | RVU17B |
| 2017-01-01 | $603.79 | $229.30 | RVU17A |
| 2016-10-01 | $560.46 | $213.89 | RVU16D |
| 2016-07-01 | $560.46 | $213.89 | RVU16C |
| 2016-04-01 | $560.46 | $213.89 | RVU16B |
| 2016-01-01 | $560.46 | $213.89 | RVU16A |
| 2015-10-01 | Separate payment rules apply | Separate payment rules apply | RVU15D |
| 2015-07-01 | Separate payment rules apply | Separate payment rules apply | RVU15C |
| 2015-04-01 | Separate payment rules apply | Separate payment rules apply | RVU15B |
| 2015-01-01 | Separate payment rules apply | Separate payment rules apply | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
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
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