Billing code 45378: ColonoscopyMedicare rate & RVUs

Medicare pays $378.10 for 45378 nationally in the office and $164.67 in a hospital or facility. Local office rates run $335.05–$497.55.

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

What 45378 covers

A gastroenterologist or colorectal surgeon advances a flexible endoscope through the colon to examine the bowel, commonly for evaluation of symptoms or an abnormal finding. The service can include specimen collection by brushing or washing, but it does not describe taking tissue for biopsy or treating a lesion. It is typically performed in an endoscopy unit or hospital outpatient department, with sedation commonly provided as part of the procedural setting.

Choose this code when the documented service is diagnostic inspection rather than a more specific colonoscopy procedure. The report should support the examination performed and whether a biopsy or treatment was done; when a more specific procedure is performed, report that service rather than separately reporting the diagnostic examination. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Modifier 53 is separately priced. Medicare does not pay an assistant at surgery for this code, and 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 45378 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

45378 rates by state

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

How the 45378 rate is calculated

Each of 45378’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.

Payment rules and modifiers for 45378

The CMS indicators that decide how 45378 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

45378 compared with similar codes

How to choose

45380Colonoscopy with biopsy

Use 45380 when tissue is sampled for biopsy. Use 45378 when the exam is diagnostic and no tissue biopsy is performed.

45385Snare polypectomy

Use 45385 when a lesion is removed by snare. Diagnostic inspection alone is reported with 45378.

45330Flexible sigmoidoscopy

45330 describes diagnostic flexible sigmoidoscopy of a limited portion of the lower bowel; 45378 is for a colonoscopy.

45379Colonoscopy

45379 applies when a foreign body is removed during colonoscopy. Without that removal or another therapeutic procedure, the diagnostic service is 45378.

Codes related to 45378

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

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

Open CMS sourceHow we calculate rates