$806.63–$1,047.59
Both involve endoscopic band ligation, but 45398 is performed during colonoscopy; 45350 is performed during sigmoidoscopy.
On this page
CMS RVU26D · Effective 2026-10-01
45398 Colonoscopy Medicare reimbursement rates in California
Reports colonoscopy with endoscopic band ligation of hemorrhoids when the intervention is performed during examination of the colon. Compare 45398 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 45398 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$967.09–$1237.77
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $270.68 per service.
Facility setting
$207.49–$238.37
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $30.88 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 45398 pays more and less in California
29 payment localities
$967.09 to $1237.77
Gastroenterology
About 45398: Colonoscopy with hemorrhoid band ligation
Reports colonoscopy with endoscopic band ligation of hemorrhoids when the intervention is performed during examination of the colon.
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.
CMS billing rules for 45398
- 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 RVU4.10 · 15%
- Practice expense (office) RVU22.32 · 83%
- Malpractice RVU0.60 · 2%
4.6K
Medicare services in 2024 · #1935 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.
45398 compared with similar codes
Office rates for California, from the same CMS release.
$398.34–$497.55
45378 describes diagnostic colonoscopy without the band-ligation intervention. Use 45398 when hemorrhoid band ligation is performed during the colonoscopy.
$778.91–$987.39
45382 is for endoscopic control of bleeding. 45398 is specific to colonoscopy with hemorrhoid band ligation.
Compare 45398 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $968.83 | Facility $209.22 |
| Chico | Office $967.09 | Facility $207.49 |
| El Centro | Office $967.19 | Facility $207.59 |
| Fresno | Office $967.09 | Facility $207.49 |
| Hanford-Corcoran | Office $967.09 | Facility $207.49 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $1037.80 | Facility $217.90 |
| Madera | Office $967.09 | Facility $207.49 |
| Merced | Office $967.09 | Facility $207.49 |
| Modesto | Office $967.09 | Facility $207.49 |
| Napa | Office $1138.33 | Facility $224.87 |
| Oxnard-Thousand Oaks-Ventura | Office $1034.45 | Facility $215.25 |
| Redding | Office $967.09 | Facility $207.49 |
| Rest Of California | Office $967.09 | Facility $207.49 |
| Riverside-San Bernardino-Ontario | Office $973.58 | Facility $213.98 |
| Sacramento-Roseville-Folsom | Office $1019.64 | Facility $213.60 |
| Salinas | Office $1015.97 | Facility $212.71 |
| San Diego-Chula Vista-Carlsbad | Office $1043.54 | Facility $214.63 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $1210.32 | Facility $233.09 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $1209.64 | Facility $232.41 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $1237.77 | Facility $238.37 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $1234.99 | Facility $235.58 |
| San Luis Obispo-Paso Robles | Office $999.15 | Facility $209.74 |
| Santa Cruz-Watsonville | Office $1056.35 | Facility $214.28 |
| Santa Maria-Santa Barbara | Office $1020.78 | Facility $212.66 |
| Santa Rosa-Petaluma | Office $1067.28 | Facility $216.19 |
| Stockton | Office $967.09 | Facility $207.49 |
| Vallejo | Office $1137.35 | Facility $223.88 |
| Visalia | Office $967.09 | Facility $207.49 |
| Yuba City | Office $967.09 | Facility $207.49 |
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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 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.
5,52745393,,Colonoscopy w/decompression,A,,4.56,1.42,NA,1.42,,0.56,6.54,6.54,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52845395,,Lap removal of rectum,A,,32.18,15.69,NA,15.69,,6.00,53.87,53.87,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,52945397,,Lap remove rectum w/pouch,A,,35.59,16.39,NA,16.39,,6.16,58.14,58.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,53045398,,Colonoscopy w/band ligation,A,,4.10,22.32,,1.57,,0.60,27.02,6.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,53145399,,Unlisted procedure colon,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,53245400,,Laparoscopic proc,A,,18.95,8.96,NA,8.96,,3.36,31.27,31.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,53345402,,Lap proctopexy w/sig resect,A,,25.85,10.84,NA,10.84,,5.01,41.70,41.70,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00