Billing code 45381: Colonoscopy injectionMedicare rate & RVUs
Colonoscopy with directed submucosal injection is reported when an endoscopist injects beneath a colonic lesion to lift it or mark its location.
Medicare pays $490.33 for 45381 nationally in the office and $177.69 in a hospital or facility. Local office rates run $432.71–$655.86.
Medicare rate · 45381
Colonoscopy injection
Swap in your local Medicare rate.
- Work RVUs
- 3.47
- Total RVUs
- 14.68
- Global days
- 000
National rate · 2026
$490.33
Office setting, before claim adjustments.
See every locality for 45381 → · 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.
On this page 10 sections
What 45381 covers
During colonoscopy, the endoscopist directs material into the tissue layer beneath the colonic lining. Common reasons include raising a flat lesion to facilitate endoscopic treatment or tattooing a lesion site for later localization. Gastroenterologists and colorectal surgeons typically perform the service in an endoscopy unit, ambulatory surgery center, hospital, or appropriately equipped office.
Report the service when the procedure record identifies the injection site, purpose, and substance or marking method. Injections during an endoscopic mucosal resection are included in the resection service; do not separately report this code for that same injection. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this colon procedure. Medicare does not pay an assistant-at-surgery service for this code; 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 45381 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$432.71 to $655.86
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $439.19 | $165.63 |
| Alaska* | $565.40 | $232.45 |
| Arizona | $477.13 | $174.19 |
| Arkansas | $432.71 | $164.15 |
| Atlanta | $499.26 | $181.62 |
| Austin | $509.86 | $179.10 |
| Bakersfield | $521.64 | $179.00 |
| Baltimore/Surr. Cntys | $521.81 | $186.36 |
| Beaumont | $456.89 | $172.40 |
| Brazoria | $484.92 | $175.10 |
| Chicago | $511.11 | $196.91 |
| Chico | $520.38 | $177.74 |
| Colorado | $511.71 | $179.07 |
| Connecticut | $523.34 | $186.63 |
| Dallas | $487.93 | $176.55 |
| Dc + Md/Va Suburbs | $562.32 | $194.04 |
| Delaware | $485.16 | $176.28 |
| Detroit | $487.33 | $185.64 |
| East St. Louis | $475.72 | $188.10 |
| El Centro | $520.45 | $177.81 |
| Fort Lauderdale | $506.35 | $189.65 |
| Fort Worth | $484.51 | $176.26 |
| Fresno | $520.38 | $177.74 |
| Galveston | $486.32 | $175.87 |
| Hanford-Corcoran | $520.38 | $177.74 |
| Hawaii, Guam | $533.79 | $178.33 |
| Houston | $494.00 | $183.56 |
| Idaho | $454.10 | $166.48 |
| Indiana | $456.81 | $167.00 |
| Iowa | $451.23 | $165.17 |
| Kansas | $448.77 | $166.15 |
| Kentucky | $449.13 | $171.20 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $556.32 | $186.47 |
| Madera | $520.38 | $177.74 |
| Manhattan | $564.35 | $201.07 |
| Merced | $520.38 | $177.74 |
| Metropolitan Boston | $563.45 | $190.17 |
| Metropolitan Kansas City | $468.02 | $174.46 |
| Metropolitan Philadelphia | $509.90 | $184.44 |
| Metropolitan St. Louis | $473.05 | $175.43 |
| Miami | $526.55 | $201.10 |
| Minnesota | $490.90 | $169.20 |
| Mississippi | $436.57 | $167.39 |
| Modesto | $520.38 | $177.74 |
| Montana** | $490.30 | $177.66 |
| Napa | $605.33 | $193.28 |
| Nebraska | $453.85 | $165.29 |
| Nevada** | $488.34 | $175.40 |
| New Hampshire | $503.35 | $177.90 |
| New Mexico | $463.23 | $176.55 |
| New Orleans | $470.97 | $176.78 |
| North Carolina | $461.11 | $169.43 |
| North Dakota** | $481.99 | $169.36 |
| Northern Nj | $556.24 | $193.59 |
| Nyc Suburbs/Long Island | $577.88 | $206.16 |
| Ohio | $459.08 | $173.65 |
| Oklahoma | $448.63 | $169.45 |
| Oxnard-Thousand Oaks-Ventura | $553.87 | $184.34 |
| Portland | $528.59 | $181.26 |
| Poughkpsie/N Nyc Suburbs | $532.72 | $190.39 |
| Puerto Rico | $494.08 | $178.01 |
| Queens | $569.54 | $200.00 |
| Redding | $520.38 | $177.74 |
| Rest Of California | $520.38 | $177.74 |
| Rest Of Florida | $481.52 | $182.65 |
| Rest Of Georgia | $454.10 | $175.23 |
| Rest Of Illinois | $466.87 | $181.44 |
| Rest Of Louisiana | $448.29 | $171.61 |
| Rest Of Maine | $456.19 | $168.57 |
| Rest Of Maryland | $494.66 | $178.27 |
| Rest Of Massachusetts | $508.43 | $179.23 |
| Rest Of Michigan | $460.78 | $175.35 |
| Rest Of Missouri | $440.23 | $170.74 |
| Rest Of New Jersey | $529.48 | $188.08 |
| Rest Of New York | $468.14 | $171.14 |
| Rest Of Oregon | $484.72 | $173.34 |
| Rest Of Pennsylvania | $460.00 | $173.00 |
| Rest Of Texas | $470.58 | $173.90 |
| Rest Of Washington | $507.58 | $178.38 |
| Rhode Island | $502.91 | $179.96 |
| Riverside-San Bernardino-Ontario | $524.95 | $182.30 |
| Sacramento-Roseville-Folsom | $546.73 | $183.14 |
| Salinas | $544.71 | $182.37 |
| San Diego-Chula Vista-Carlsbad | $558.01 | $184.11 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $641.51 | $200.70 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $641.03 | $200.22 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $655.86 | $205.04 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $653.91 | $203.09 |
| San Luis Obispo-Paso Robles | $535.88 | $179.79 |
| Santa Cruz-Watsonville | $563.74 | $183.89 |
| Santa Maria-Santa Barbara | $546.89 | $182.36 |
| Santa Rosa-Petaluma | $569.46 | $185.55 |
| Seattle (King Cnty) | $575.36 | $191.76 |
| South Carolina | $460.83 | $171.96 |
| South Dakota** | $481.01 | $168.38 |
| Southern Maine | $481.91 | $172.09 |
| Stockton | $520.38 | $177.74 |
| Suburban Chicago | $511.70 | $190.62 |
| Tennessee | $451.03 | $166.85 |
| Utah | $467.27 | $173.40 |
| Vallejo | $604.64 | $192.59 |
| Vermont | $479.79 | $170.29 |
| Virgin Islands | $494.08 | $178.01 |
| Virginia | $480.07 | $172.76 |
| Visalia | $520.38 | $177.74 |
| West Virginia | $449.16 | $177.48 |
| Wisconsin | $465.48 | $165.98 |
| Wyoming** | $486.68 | $174.05 |
| Yuba City | $520.38 | $177.74 |
45381 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.
$432.71
$588.12
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 | $565.40 | 1 |
| AL | $439.19 | 1 |
| AR | $432.71 | 1 |
| AZ | $477.13 | 1 |
| CA | $520.38–$655.86 | 29 |
| CO | $511.71 | 1 |
| CT | $523.34 | 1 |
| DC | $562.32 | 1 |
| DE | $485.16 | 1 |
| FL | $481.52–$526.55 | 3 |
| GA | $454.10–$499.26 | 2 |
| GU | $533.79 | 1 |
| HI | $533.79 | 1 |
| IA | $451.23 | 1 |
| ID | $454.10 | 1 |
| IL | $466.87–$511.70 | 4 |
| IN | $456.81 | 1 |
| KS | $448.77 | 1 |
| KY | $449.13 | 1 |
| LA | $448.29–$470.97 | 2 |
| MA | $508.43–$563.45 | 2 |
| MD | $494.66–$562.32 | 3 |
| ME | $456.19–$481.91 | 2 |
| MI | $460.78–$487.33 | 2 |
| MN | $490.90 | 1 |
| MO | $440.23–$473.05 | 3 |
| MS | $436.57 | 1 |
| MT | $490.30 | 1 |
| NC | $461.11 | 1 |
| ND | $481.99 | 1 |
| NE | $453.85 | 1 |
| NH | $503.35 | 1 |
| NJ | $529.48–$556.24 | 2 |
| NM | $463.23 | 1 |
| NV | $488.34 | 1 |
| NY | $468.14–$577.88 | 5 |
| OH | $459.08 | 1 |
| OK | $448.63 | 1 |
| OR | $484.72–$528.59 | 2 |
| PA | $460.00–$509.90 | 2 |
| PR | $494.08 | 1 |
| RI | $502.91 | 1 |
| SC | $460.83 | 1 |
| SD | $481.01 | 1 |
| TN | $451.03 | 1 |
| TX | $456.89–$509.86 | 8 |
| UT | $467.27 | 1 |
| VA | $480.07–$562.32 | 2 |
| VI | $494.08 | 1 |
| VT | $479.79 | 1 |
| WA | $507.58–$575.36 | 2 |
| WI | $465.48 | 1 |
| WV | $449.16 | 1 |
| WY | $486.68 | 1 |
How the 45381 rate is calculated
Each of 45381’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 · 45381
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.47Practice expense 10.79Malpractice 0.42
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45381
The CMS indicators that decide how 45381 is paid alongside other services.
CMS payment indicators · 45381
Colonoscopy injection
| 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
45381 without 51 · national office
$490.33
Colonoscopy injection
45381-51 · Second procedure: 50%
$245.17
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%).
45381 compared with similar codes
Compare codes
45381 vs 45380 vs 45382 vs 45390: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45380Colonoscopy with biopsy
- This code describes injection beneath the lining; 45380 describes taking tissue for examination. Choose based on the intervention documented.
- 45382Colonoscopy
- Use 45382 when the endoscopist treats bleeding. Injection to lift or mark a lesion is the service described here.
- 45390Colonoscopy
- When injection is part of endoscopic mucosal resection, 45390 includes it. Do not separately report this code for that same injection.
45381 billing questions
When should this code be chosen instead of a biopsy code?
Use it for directed injection beneath the colonic lining, such as lifting or marking a lesion. Use the biopsy code when tissue sampling is the intervention.
Can it be reported with endoscopic mucosal resection?
The mucosal resection code includes submucosal injection when performed as part of that resection. Do not separately report this code for the same injection.
How many units should be reported for several injections?
Multiple directed injections during one colonoscopy do not create separate units; the code covers injection or injections.
What documentation supports reporting it?
Record the colonic site, why material was injected, and the substance or marking method used. Document whether the injection lifted a lesion or marked its location.
Which modifiers or surgical-assistance services are appropriate?
Modifier 50 is inappropriate for this colon procedure. Medicare does not pay an assistant-at-surgery service for this code, and co-surgeon and team-surgery reporting are not permitted.
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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