$833.95
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 Guam
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 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 45398 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
$996.19
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$208.17
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.
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 Guam, from the same CMS release.
$407.70
45378 describes diagnostic colonoscopy without the band-ligation intervention. Use 45398 when hemorrhoid band ligation is performed during the colonoscopy.
$800.08
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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$996.19
Facility
$208.17
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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 45398 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,530
- Code
- 45398
- Physician work
- 4.10
- Practice expense
- 22.32
- Malpractice
- 0.60
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.10 | × 1.000 | 4.1000 |
| Practice expense | 22.32 | × 1.137 | 25.3778 |
| Malpractice | 0.60 | × 0.579 | 0.3474 |
| Total RVUs | 29.8252 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$996.19
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.1 | 1 |
| Practice expense | 22.32 | 1.137 |
| Malpractice | 0.6 | 0.579 |
(4.1 × 1 + 22.32 × 1.137 + 0.6 × 0.579) × $33.4009 = $996.19
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.1 | 1 |
| Practice expense | 1.57 | 1.137 |
| Malpractice | 0.6 | 0.579 |
(4.1 × 1 + 1.57 × 1.137 + 0.6 × 0.579) × $33.4009 = $208.17
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.
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
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