$407.70
45378 is colonoscopy with no tissue sampling or intervention. Once a forceps biopsy is taken, report 45380 instead and do not add 45378.
On this page
CMS RVU26D · Effective 2026-10-01
45380 Colonoscopy with biopsy Medicare reimbursement rates in Guam
Flexible colonoscopy past the splenic flexure in which one or more tissue samples are taken with biopsy forceps, reported once per session regardless of sample count. Compare 45380 office and facility rates across CMS payment localities in Guam.
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 45380 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$522.02
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$178.33
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Gastrointestinal endoscopy
About 45380: Colonoscopy with single or multiple biopsies
Flexible colonoscopy past the splenic flexure in which one or more tissue samples are taken with biopsy forceps, reported once per session regardless of sample count.
The endoscopist advances a flexible colonoscope through the rectum and colon, typically to the cecum, and uses biopsy forceps to sample mucosa or lesions. Common indications include suspected inflammatory bowel disease, chronic diarrhea with random biopsies for microscopic colitis, and evaluation of a mass. Small polyps removed with cold biopsy forceps are also reported with 45380. Gastroenterologists and general or colorectal surgeons perform the procedure, mostly in hospital outpatient departments and ambulatory surgery centers, with a smaller share in offices.
Report one unit per colonoscopy session regardless of the number of biopsies or sites sampled; document the sites and extent reached. Diagnostic colonoscopy 45378 is included and is not billed separately. When related colonoscopy procedures are reported together, endoscopy family pricing pays the highest-valued procedure in full and reduces each additional procedure by the family's base endoscopy value. The 0-day global includes routine same-day preoperative and postoperative care. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate. Append modifier PT when a Medicare screening colonoscopy leads to biopsy.
CMS billing rules for 45380
- 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) RVU10.48 · 73%
- Malpractice RVU0.42 · 3%
1.3M
Medicare services in 2024 · #125 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.
45380 compared with similar codes
Office rates for Guam, from the same CMS release.
$538.60
45385 is lesion removal by snare. Tissue sampling or cold forceps removal is 45380; both are billed only when they address different lesions.
$583.79
45384 is removal using hot biopsy forceps with cautery. Cold forceps biopsy or removal without cautery stays with 45380.
$359.55
45331 is flexible sigmoidoscopy with biopsy, examining as far as the splenic flexure. Use 45380 when the colonoscopy extends beyond the splenic flexure and includes a biopsy.
Compare 45380 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$522.02
Facility
$178.33
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 45380 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,516
- Code
- 45380
- Physician work
- 3.47
- Practice expense
- 10.48
- Malpractice
- 0.42
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.47 | × 1.000 | 3.4700 |
| Practice expense | 10.48 | × 1.137 | 11.9158 |
| Malpractice | 0.42 | × 0.579 | 0.2432 |
| Total RVUs | 15.6289 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$522.02
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.47 | 1 |
| Practice expense | 10.48 | 1.137 |
| Malpractice | 0.42 | 0.579 |
(3.47 × 1 + 10.48 × 1.137 + 0.42 × 0.579) × $33.4009 = $522.02
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.47 | 1 |
| Practice expense | 1.43 | 1.137 |
| Malpractice | 0.42 | 0.579 |
(3.47 × 1 + 1.43 × 1.137 + 0.42 × 0.579) × $33.4009 = $178.33
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.
45380 billing questions
How many units are reported when several biopsies are taken from different segments?
One unit. The code covers single or multiple biopsies during the same colonoscopy, so random biopsies from the ascending, transverse, and sigmoid colon are still a single line.
Can 45380 be billed with snare polypectomy 45385 in the same session?
Yes, when the biopsy is of a different lesion than the one removed by snare. Append modifier 59 or XS to 45380 and document separate lesions; biopsy of the same lesion before snaring is not separately reported.
Which code applies when a small polyp is removed with cold biopsy forceps?
Cold forceps removal is reported with 45380. Hot biopsy forceps removal goes to 45384, and snare removal, hot or cold, goes to 45385.
What modifier is needed when a Medicare screening colonoscopy turns into a biopsy?
Report 45380 with modifier PT to identify the procedure as a screening colonoscopy converted to biopsy. The Medicare Part B deductible is waived.
Is the pathology work included in 45380?
No. The endoscopist's code covers obtaining the tissue only; the pathologist separately reports the specimen examination, commonly with 88305 for each separately submitted specimen.
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.
5,51345378,,Diagnostic colonoscopy,A,,3.18,7.73,,1.34,,0.41,11.32,4.93,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,51445378,53,Diagnostic colonoscopy,A,,1.59,3.87,,0.67,,0.21,5.67,2.47,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,51545379,,Colonoscopy w/fb removal,A,,4.17,9.69,,1.63,,0.49,14.35,6.29,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,51645380,,Colonoscopy and biopsy,A,,3.47,10.48,,1.43,,0.42,14.37,5.32,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,51745381,,Colonoscopy submucous njx,A,,3.47,10.79,,1.43,,0.42,14.68,5.32,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,51845382,,Colonoscopy w/control bleed,A,,4.54,16.82,,1.75,,0.50,21.86,6.79,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,51945384,,Colonoscopy w/lesion removal,A,,3.97,11.57,,1.51,,0.61,16.15,6.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014