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Billing code 45391: Colonoscopy EUSMedicare rate & RVUs

Reports a full colonoscopy with endoscopic ultrasound to assess bowel-wall lesions, rectal abnormalities, or nearby structures without EUS-guided tissue sampling.

CMS RVU26DEffective Oct 1, 2026109 payment localities713 Medicare services in 2024

Medicare pays $226.12 for 45391 nationally in a facility.

Medicare rate · 45391

Colonoscopy EUS

Work RVUs
4.52
Total RVUs
6.77
Global days
000

National rate · 2026

$226.12

Facility setting, before claim adjustments.

See every locality for 45391 →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
  1. Medicare rate
  2. What 45391 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 45391 covers

A gastroenterologist or other qualified endoscopist advances a colonoscope to examine the colon and uses an ultrasound transducer during the procedure to assess bowel-wall layers and adjacent anatomy. Common reasons include evaluating a subepithelial lesion, characterizing a rectal mass, or assessing local rectal cancer extent. The procedure is typically performed in a hospital endoscopy unit or ambulatory endoscopy center.

Select this code when the colonoscopy includes endoscopic ultrasound examination without ultrasound-guided needle sampling; when EUS guides fine-needle aspiration or biopsy, compare 45392. The report should identify the findings and document the ultrasound examination. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare 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.

Where 45391 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

45391 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$211.67
Alaska*Unavailable$298.08
ArizonaUnavailable$221.94
ArkansasUnavailable$209.90
AtlantaUnavailable$230.81
AustinUnavailable$227.97
BakersfieldUnavailable$228.24
Baltimore/Surr. CntysUnavailable$236.71
BeaumontUnavailable$219.67
BrazoriaUnavailable$223.20

45391 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
45391 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 45391 rate is calculated

Each of 45391’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 · 45391

RVUs × geographic indexes × conversion factor

Work4.52

4.52 RVUs× 1.000 GPCI

Practice expense1.76

1.76 RVUs× 1.000 GPCI

Malpractice0.49

0.49 RVUs× 1.000 GPCI

Adjusted RVUs

6.7700

Conversion factor

$33.4009

Medicare rate

$226.12

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

Payment rules and modifiers for 45391

The CMS indicators that decide how 45391 is paid alongside other services.

CMS payment indicators · 45391

Colonoscopy EUS

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

45391 without 51 · national facility

$226.12

Colonoscopy EUS

45391-51 · Second procedure: 50%

$113.06

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

45391 compared with similar codes

Compare codes · National

5 codes, side by side

  • 45391

    Colonoscopy EUS4.52 wRVU

    Not priced

  • 45392

    Colonoscopy with EUS5.36 wRVU

    Not priced

  • 45341

    Sigmoidoscopy ultrasound2.07 wRVU

    Not priced

  • 45342

    Sigmoidoscopy2.91 wRVU

    Not priced

  • 45378

    Colonoscopy3.18 wRVU

    $378.10

How to choose

45392Colonoscopy with EUS
Choose 45391 for colonoscopy with EUS examination alone. Choose 45392 when EUS guides fine-needle aspiration or biopsy.
45341Sigmoidoscopy ultrasound
45341 is sigmoidoscopy with ultrasound, while 45391 describes colonoscopy with ultrasound. Select based on the scope examination performed.
45342Sigmoidoscopy
45342 combines sigmoidoscopy, ultrasound, and ultrasound-guided biopsy; 45391 is the colonoscopy EUS examination without that guided sampling.
45378Colonoscopy
45378 is diagnostic colonoscopy without EUS. Use 45391 when endoscopic ultrasound is also performed during the colonoscopy.

Codes related to 45391

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

Codes related to 45391
CodeHow it relatesNational office range
Same family
45392Colonoscopy with EUSColonoscopy with EUS-guided tissue sampling, rather than examination alone.No office rate
Used instead
45341Sigmoidoscopy ultrasoundSigmoidoscopy with ultrasound for an examination limited to the sigmoid or rectum.No office rate
45342SigmoidoscopySigmoidoscopy with ultrasound-guided biopsy when the examination is limited to that extent.No office rate
45378ColonoscopyDiagnostic colonoscopy without the endoscopic ultrasound service.$335.05–$497.55

45391 billing questions

When should 45392 be used instead?

Use 45392 when endoscopic ultrasound guides fine-needle aspiration or biopsy. Code 45391 describes the ultrasound examination without that guided tissue-sampling service.

Can diagnostic colonoscopy 45378 also be reported for the same session?

The diagnostic inspection that is part of the same colonoscopy is included; do not separately report 45378 for that same examination.

How does 45391 differ from sigmoidoscopy with ultrasound?

45391 describes colonoscopy with EUS. For an examination limited to the sigmoid colon or rectum, compare the sigmoidoscopy ultrasound code 45341.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy does not support bilateral reporting.

What happens when related endoscopies are performed in the same session?

CMS applies endoscopy family pricing to related endoscopies performed together. The claim should reflect the procedures actually performed, with payment determined under that family rule.

What documentation supports reporting 45391?

Document the colonoscopy, the endoscopic ultrasound examination, the anatomy assessed, and the findings. If EUS-guided needle sampling was performed, evaluate 45392 instead.

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 45391PPRRVU2026_Oct_nonQPP.csv, line 5,525 (RVU26D)

Open CMS sourceHow we calculate rates

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