Billing code 45379: ColonoscopyMedicare rate & RVUs in Illinois
Report this service when a colonoscopy is used to retrieve a foreign object from the colon, rather than only to inspect or sample tissue.
Medicare pays $460.36–$503.09 for 45379 in the office in Illinois, from Rest Of Illinois to Chicago. 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 45379 covers
A gastroenterologist or colorectal surgeon uses a colonoscope to locate and retrieve foreign material in the colon, often with an endoscopic retrieval device or forceps. The service may be performed in a hospital or ambulatory endoscopy setting when an object requires endoscopic removal. The record should identify the foreign material, its location, and the retrieval performed; routine inspection that does not include removal is not this service.
Select this code when the documented colonoscopy includes foreign-body retrieval, not when the procedure only evaluates the colon, takes a biopsy, or removes a lesion. The diagnostic examination is part of the therapeutic procedure. CMS assigns 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 for this anatomy and service. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery 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 45379 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$460.36 to $503.09
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $503.09 | $232.53 |
| East St. Louis | $470.01 | $222.33 |
| Rest Of Illinois | $460.36 | $214.57 |
| Suburban Chicago | $501.65 | $225.17 |
How the 45379 rate is calculated
Each of 45379’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 · 45379
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.17Practice expense 9.69Malpractice 0.49
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45379
The CMS indicators that decide how 45379 is paid alongside other services.
CMS payment indicators · 45379
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
45379 without 51 · national office
$479.30
Colonoscopy
45379-51 · Second procedure: 50%
$239.65
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%).
45379 compared with similar codes
Compare codes
45379 vs 45378 vs 45380 vs 45384 vs 45385: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45378Colonoscopy
- 45378 describes a diagnostic colonoscopy without a therapeutic removal. Choose 45379 when the colonoscopy includes retrieval of a foreign object.
- 45380Colonoscopy with biopsy
- 45380 is for colonoscopic tissue sampling. It does not describe retrieval of foreign material.
- 45384Colonoscopy polyp removal
- 45384 describes removal of a tumor, polyp, or other lesion by specified cautery methods. Use 45379 when the target is a foreign object, not a lesion.
- 45385Snare polypectomy
- 45385 describes lesion removal by snare. A snare used to retrieve a foreign object does not make the service lesion removal.
45379 billing questions
How is this different from a diagnostic colonoscopy?
Use this code when the colonoscopy includes retrieval of a foreign object. A colonoscopy performed only to examine the colon, without foreign-body removal, is reported as a diagnostic colonoscopy.
Should a biopsy or lesion-removal code be used instead?
Use a biopsy or lesion-removal code when tissue is sampled or a lesion is removed, rather than a foreign object. The operative report should make clear what was retrieved or treated.
Can a diagnostic colonoscopy also be reported for the same procedure?
The inspection needed to locate and retrieve the foreign object is part of the therapeutic colonoscopy. CMS endoscopy family pricing applies when related endoscopies are performed together.
Does modifier 50 apply?
No. CMS identifies bilateral adjustment as inappropriate for this service and anatomy.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What documentation supports reporting this code?
Document the foreign material, its location in the colon, and the endoscopic retrieval performed. The record should distinguish retrieval from biopsy, lesion removal, or inspection alone.
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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