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CMS RVU26D · Effective 2026-10-01

45381 in Merced

Office / nonfacility

$520.38

Base rate per service

Facility setting

$177.74

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Gastrointestinal endoscopy

About 45381: Colonoscopy with submucosal injection

Colonoscopy with directed submucosal injection is reported when an endoscopist injects beneath a colonic lesion to lift it or mark its location.

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.

CMS billing rules for 45381

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Endoscopy family pricing applies when related endoscopies are performed together.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU3.47 · 24%
  • Practice expense (office) RVU10.79 · 74%
  • Malpractice RVU0.42 · 3%

81.9K

Medicare services in 2024 · #621 by national volume

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.

45381 compared with similar codes

Office rates for Merced, from the same CMS release.

45380

Colonoscopy with biopsy

Single or multiple forceps biopsies

$509.04

This code describes injection beneath the lining; 45380 describes taking tissue for examination. Choose based on the intervention documented.

45382

Colonoscopy

Control of bleeding

$778.91

Use 45382 when the endoscopist treats bleeding. Injection to lift or mark a lesion is the service described here.

45390

Colonoscopy

Mucosal lesion resection

No office rate

When injection is part of endoscopic mucosal resection, 45390 includes it. Do not separately report this code for that same injection.

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 45381 is $521.64—$1.26 higher than the $520.38 rate in Merced. Both use the same code, release and participation basis.

45381 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $520.38

  2. Bakersfield

    $521.64

    $1.26 higher than Merced

  3. Chico

    $520.38

    The same base rate than Merced

  4. El Centro

    $520.45

    $0.07 higher than Merced

  5. Fresno

    $520.38

    The same base rate than Merced

  6. Hanford-Corcoran

    $520.38

    The same base rate than Merced

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $556.32

    $35.94 higher than Merced

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 45381 ranges from $432.71 in Arkansas to $655.86 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Modesto

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Napa

    California · 45381

    Office

    $605.33

    Facility

    $193.28

    $84.95 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 45381

    Office

    $553.87

    Facility

    $184.34

    $33.49 higher than Merced for the office setting.

  • Redding

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 45381

    Office

    $524.95

    Facility

    $182.30

    $4.57 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 45381

    Office

    $546.73

    Facility

    $183.14

    $26.35 higher than Merced for the office setting.

  • Salinas

    California · 45381

    Office

    $544.71

    Facility

    $182.37

    $24.33 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 45381

    Office

    $558.01

    Facility

    $184.11

    $37.63 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 45381

    Office

    $641.51

    Facility

    $200.70

    $121.13 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 45381

    Office

    $641.03

    Facility

    $200.22

    $120.65 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 45381

    Office

    $655.86

    Facility

    $205.04

    $135.48 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 45381

    Office

    $653.91

    Facility

    $203.09

    $133.53 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 45381

    Office

    $535.88

    Facility

    $179.79

    $15.50 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 45381

    Office

    $563.74

    Facility

    $183.89

    $43.36 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 45381

    Office

    $546.89

    Facility

    $182.36

    $26.51 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 45381

    Office

    $569.46

    Facility

    $185.55

    $49.08 higher than Merced for the office setting.

  • Stockton

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 45381

    Office

    $604.64

    Facility

    $192.59

    $84.26 higher than Merced for the office setting.

  • Visalia

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 45381

    Office

    $520.38

    Facility

    $177.74

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 45381

    Office

    $562.32

    Facility

    $194.04

    $41.94 higher than Merced for the office setting.

  • Miami

    Florida · 45381

    Office

    $526.55

    Facility

    $201.10

    $6.17 higher than Merced for the office setting.

  • Chicago

    Illinois · 45381

    Office

    $511.11

    Facility

    $196.91

    $9.27 lower than Merced for the office setting.

  • Manhattan

    New York · 45381

    Office

    $564.35

    Facility

    $201.07

    $43.97 higher than Merced for the office setting.

  • Alaska*

    Alaska · 45381

    Office

    $565.40

    Facility

    $232.45

    $45.02 higher than Merced for the office setting.

  • Alabama

    Alabama · 45381

    Office

    $439.19

    Facility

    $165.63

    $81.19 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 45381

    Office

    $432.71

    Facility

    $164.15

    $87.67 lower than Merced for the office setting.

  • Arizona

    Arizona · 45381

    Office

    $477.13

    Facility

    $174.19

    $43.25 lower than Merced for the office setting.

  • Colorado

    Colorado · 45381

    Office

    $511.71

    Facility

    $179.07

    $8.67 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 45381

    Office

    $523.34

    Facility

    $186.63

    $2.96 higher than Merced for the office setting.

  • Delaware

    Delaware · 45381

    Office

    $485.16

    Facility

    $176.28

    $35.22 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 45381

    Office

    $506.35

    Facility

    $189.65

    $14.03 lower than Merced for the office setting.

  • Rest Of Florida

    Florida · 45381

    Office

    $481.52

    Facility

    $182.65

    $38.86 lower than Merced for the office setting.

  • Atlanta

    Georgia · 45381

    Office

    $499.26

    Facility

    $181.62

    $21.12 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 45381

    Office

    $454.10

    Facility

    $175.23

    $66.28 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 45381

    Office

    $533.79

    Facility

    $178.33

    $13.41 higher than Merced for the office setting.

  • Iowa

    Iowa · 45381

    Office

    $451.23

    Facility

    $165.17

    $69.15 lower than Merced for the office setting.

  • Idaho

    Idaho · 45381

    Office

    $454.10

    Facility

    $166.48

    $66.28 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 45381

    Office

    $475.72

    Facility

    $188.10

    $44.66 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 45381

    Office

    $466.87

    Facility

    $181.44

    $53.51 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 45381

    Office

    $511.70

    Facility

    $190.62

    $8.68 lower than Merced for the office setting.

  • Indiana

    Indiana · 45381

    Office

    $456.81

    Facility

    $167.00

    $63.57 lower than Merced for the office setting.

  • Kansas

    Kansas · 45381

    Office

    $448.77

    Facility

    $166.15

    $71.61 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 45381

    Office

    $449.13

    Facility

    $171.20

    $71.25 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 45381

    Office

    $470.97

    Facility

    $176.78

    $49.41 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 45381

    Office

    $448.29

    Facility

    $171.61

    $72.09 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 45381

    Office

    $563.45

    Facility

    $190.17

    $43.07 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 45381

    Office

    $508.43

    Facility

    $179.23

    $11.95 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 45381

    Office

    $521.81

    Facility

    $186.36

    $1.43 higher than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 45381

    Office

    $494.66

    Facility

    $178.27

    $25.72 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 45381

    Office

    $456.19

    Facility

    $168.57

    $64.19 lower than Merced for the office setting.

  • Southern Maine

    Maine · 45381

    Office

    $481.91

    Facility

    $172.09

    $38.47 lower than Merced for the office setting.

  • Detroit

    Michigan · 45381

    Office

    $487.33

    Facility

    $185.64

    $33.05 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 45381

    Office

    $460.78

    Facility

    $175.35

    $59.60 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 45381

    Office

    $490.90

    Facility

    $169.20

    $29.48 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 45381

    Office

    $468.02

    Facility

    $174.46

    $52.36 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 45381

    Office

    $473.05

    Facility

    $175.43

    $47.33 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 45381

    Office

    $440.23

    Facility

    $170.74

    $80.15 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 45381

    Office

    $436.57

    Facility

    $167.39

    $83.81 lower than Merced for the office setting.

  • Montana**

    Montana · 45381

    Office

    $490.30

    Facility

    $177.66

    $30.08 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 45381

    Office

    $461.11

    Facility

    $169.43

    $59.27 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 45381

    Office

    $481.99

    Facility

    $169.36

    $38.39 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 45381

    Office

    $453.85

    Facility

    $165.29

    $66.53 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 45381

    Office

    $503.35

    Facility

    $177.90

    $17.03 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 45381

    Office

    $556.24

    Facility

    $193.59

    $35.86 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 45381

    Office

    $529.48

    Facility

    $188.08

    $9.10 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 45381

    Office

    $463.23

    Facility

    $176.55

    $57.15 lower than Merced for the office setting.

  • Nevada**

    Nevada · 45381

    Office

    $488.34

    Facility

    $175.40

    $32.04 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 45381

    Office

    $577.88

    Facility

    $206.16

    $57.50 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 45381

    Office

    $532.72

    Facility

    $190.39

    $12.34 higher than Merced for the office setting.

  • Queens

    New York · 45381

    Office

    $569.54

    Facility

    $200.00

    $49.16 higher than Merced for the office setting.

  • Rest Of New York

    New York · 45381

    Office

    $468.14

    Facility

    $171.14

    $52.24 lower than Merced for the office setting.

  • Ohio

    Ohio · 45381

    Office

    $459.08

    Facility

    $173.65

    $61.30 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 45381

    Office

    $448.63

    Facility

    $169.45

    $71.75 lower than Merced for the office setting.

  • Portland

    Oregon · 45381

    Office

    $528.59

    Facility

    $181.26

    $8.21 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 45381

    Office

    $484.72

    Facility

    $173.34

    $35.66 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 45381

    Office

    $509.90

    Facility

    $184.44

    $10.48 lower than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 45381

    Office

    $460.00

    Facility

    $173.00

    $60.38 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 45381

    Office

    $494.08

    Facility

    $178.01

    $26.30 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 45381

    Office

    $502.91

    Facility

    $179.96

    $17.47 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 45381

    Office

    $460.83

    Facility

    $171.96

    $59.55 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 45381

    Office

    $481.01

    Facility

    $168.38

    $39.37 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 45381

    Office

    $451.03

    Facility

    $166.85

    $69.35 lower than Merced for the office setting.

  • Austin

    Texas · 45381

    Office

    $509.86

    Facility

    $179.10

    $10.52 lower than Merced for the office setting.

  • Beaumont

    Texas · 45381

    Office

    $456.89

    Facility

    $172.40

    $63.49 lower than Merced for the office setting.

  • Brazoria

    Texas · 45381

    Office

    $484.92

    Facility

    $175.10

    $35.46 lower than Merced for the office setting.

  • Dallas

    Texas · 45381

    Office

    $487.93

    Facility

    $176.55

    $32.45 lower than Merced for the office setting.

  • Fort Worth

    Texas · 45381

    Office

    $484.51

    Facility

    $176.26

    $35.87 lower than Merced for the office setting.

  • Galveston

    Texas · 45381

    Office

    $486.32

    Facility

    $175.87

    $34.06 lower than Merced for the office setting.

  • Houston

    Texas · 45381

    Office

    $494.00

    Facility

    $183.56

    $26.38 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 45381

    Office

    $470.58

    Facility

    $173.90

    $49.80 lower than Merced for the office setting.

  • Utah

    Utah · 45381

    Office

    $467.27

    Facility

    $173.40

    $53.11 lower than Merced for the office setting.

  • Virginia

    Virginia · 45381

    Office

    $480.07

    Facility

    $172.76

    $40.31 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 45381

    Office

    $494.08

    Facility

    $178.01

    $26.30 lower than Merced for the office setting.

  • Vermont

    Vermont · 45381

    Office

    $479.79

    Facility

    $170.29

    $40.59 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 45381

    Office

    $507.58

    Facility

    $178.38

    $12.80 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 45381

    Office

    $575.36

    Facility

    $191.76

    $54.98 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 45381

    Office

    $465.48

    Facility

    $165.98

    $54.90 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 45381

    Office

    $449.16

    Facility

    $177.48

    $71.22 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 45381

    Office

    $486.68

    Facility

    $174.05

    $33.70 lower than Merced for the office setting.

See how rates vary across the country

45381 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$432.71

$588.12

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$565.401
AL$439.191
AR$432.711
AZ$477.131
CA$520.38–$655.8629
CO$511.711
CT$523.341
DC$562.321
DE$485.161
FL$481.52–$526.553
GA$454.10–$499.262
GU$533.791
HI$533.791
IA$451.231
ID$454.101
IL$466.87–$511.704
IN$456.811
KS$448.771
KY$449.131
LA$448.29–$470.972
MA$508.43–$563.452
MD$494.66–$562.323
ME$456.19–$481.912
MI$460.78–$487.332
MN$490.901
MO$440.23–$473.053
MS$436.571
MT$490.301
NC$461.111
ND$481.991
NE$453.851
NH$503.351
NJ$529.48–$556.242
NM$463.231
NV$488.341
NY$468.14–$577.885
OH$459.081
OK$448.631
OR$484.72–$528.592
PA$460.00–$509.902
PR$494.081
RI$502.911
SC$460.831
SD$481.011
TN$451.031
TX$456.89–$509.868
UT$467.271
VA$480.07–$562.322
VI$494.081
VT$479.791
WA$507.58–$575.362
WI$465.481
WV$449.161
WY$486.681

Explore 45381 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 45381 in Merced, the physician’s office rate is $520.38 and the facility-setting rate is $177.74: a difference of $342.64.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 45381 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$572.42

$520.38 × 110% = $572.42

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45381 in Merced.

PPRRVU2026_Oct_nonQPP.csv

5,517

Code
45381
Physician work
3.47
Practice expense
10.79
Malpractice
0.42

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 45381 in Merced
ComponentRVULocality factorAdjusted
Physician work3.47× 1.0173.5290
Practice expense10.79× 1.09611.8258
Malpractice0.42× 0.5360.2251
Total RVUs15.5800
Conversion factor× 33.4009

Office / nonfacility rate, Merced$520.38

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 45381 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.471.017
Practice expense10.791.096
Malpractice0.420.536

(3.47 × 1.017 + 10.79 × 1.096 + 0.42 × 0.536) × $33.4009 = $520.38

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.471.017
Practice expense1.431.096
Malpractice0.420.536

(3.47 × 1.017 + 1.43 × 1.096 + 0.42 × 0.536) × $33.4009 = $177.74

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

45381 · Office / nonfacility

$520.38

Effective 2026-10-01

The base rate is $75.49 higher than on 2025-10-01, moving from $444.89 to $520.38 (17.0%).

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

    $444.89changed to$520.38

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.56 changed to 3.47
    • Practice expense RVU 9.04 changed to 10.79
    • Malpractice RVU 0.47 changed to 0.42
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $444.89

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$520.38$177.74RVU26D
2026-07-01$520.38$177.74RVU26C
2026-04-01$520.38$177.74RVU26B
2026-01-01$520.38$177.74RVU26A
2025-10-01$444.89$193.51RVU25D
2025-07-01$444.89$193.51RVU25C
2025-04-01$444.89$193.51RVU25B
2025-01-01$444.89$193.51RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 45381PPRRVU2026_Oct_nonQPP.csv, line 5,517 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet