Billing code 45386: ColonoscopyMedicare rate & RVUs in Florida
Report this therapeutic colonoscopy when a flexible colonoscope is used to widen a narrowed colonic segment with an endoscopic balloon.
Medicare pays $654.31–$714.67 for 45386 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 45386 covers
A gastroenterologist or colorectal surgeon uses a flexible colonoscope to locate a narrowed area of the colon and expand it with a balloon passed through the scope. The service is commonly performed in a hospital outpatient endoscopy unit or ambulatory surgery center for a colonic stricture, such as narrowing at a surgical anastomosis or associated with inflammatory disease. The balloon dilation is the defining treatment, rather than biopsy, lesion removal, or another endoscopic intervention.
Choose this code when the service is a colonoscopy with balloon dilation; use the sigmoidoscopy dilation code when the examination is limited to the distal colon. The report should identify the narrowed segment and document the dilation performed. A diagnostic examination of the same colon during the therapeutic session is part of the service. CMS applies endoscopy family pricing when related endoscopies are performed together. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing 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 45386 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$654.31 to $714.67
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $689.16 | $199.90 |
| Miami | $714.67 | $211.89 |
| Rest Of Florida | $654.31 | $192.58 |
How the 45386 rate is calculated
Each of 45386’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 · 45386
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.68Practice expense 15.95Malpractice 0.44
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45386
The CMS indicators that decide how 45386 is paid alongside other services.
CMS payment indicators · 45386
Colonoscopy
| 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
45386 without 51 · national office
$670.36
Colonoscopy
45386-51 · Second procedure: 50%
$335.18
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%).
45386 compared with similar codes
Compare codes
45386 vs 45340 vs 45378 vs 45380: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45340Sigmoidoscopy dilation
- Both describe balloon dilation, but 45340 is performed during flexible sigmoidoscopy. Use 45386 when the service is a colonoscopy.
- 45378Colonoscopy
- 45378 describes a diagnostic colonoscopy without a therapeutic intervention. Balloon dilation during the colonoscopy points to 45386 instead.
- 45380Colonoscopy with biopsy
- 45380 describes colonoscopy with biopsy, not balloon treatment of a narrowing. If both services are performed, account for CMS endoscopy family pricing.
45386 billing questions
When should this code be used instead of 45340?
Use this code for balloon dilation performed through a colonoscope. Code 45340 describes balloon dilation during flexible sigmoidoscopy, a more limited examination.
Can 45378 also be reported for the same session?
The diagnostic inspection performed as part of the therapeutic colonoscopy is included. Do not separately report 45378 for that same examination.
What documentation supports reporting balloon dilation?
Document the colonic narrowing and location, the use of an endoscopic balloon, and the dilation performed. The record should make clear that balloon treatment—not another therapeutic technique—was provided.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. CMS assigns a 0-day global period.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for it; co-surgeons and team surgery are also 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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