$470.46–$524.47
Both describe balloon dilation, but 45340 is performed during flexible sigmoidoscopy. Use 45386 when the service is a colonoscopy.
On this page
CMS RVU26D · Effective 2026-10-01
45386 Colonoscopy Medicare reimbursement rates in Illinois
Report this therapeutic colonoscopy when a flexible colonoscope is used to widen a narrowed colonic segment with an endoscopic balloon. Compare 45386 office and facility rates across CMS payment localities in Illinois.
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 45386 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$632.28–$696.95
4 of 4 localities have a supported rate.
Facility setting
$191.32–$207.52
4 of 4 localities have a supported rate.
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 45386 pays more and less in Illinois
4 payment localities
$632.28 to $696.95
Gastroenterology
About 45386: Colonoscopy with balloon stricture dilation
Report this therapeutic colonoscopy when a flexible colonoscope is used to widen a narrowed colonic segment with an endoscopic balloon.
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.
CMS billing rules for 45386
- 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 RVU3.68 · 18%
- Practice expense (office) RVU15.95 · 79%
- Malpractice RVU0.44 · 2%
2.3K
Medicare services in 2024 · #2348 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.
45386 compared with similar codes
Office rates for Illinois, from the same CMS release.
$363.35–$397.87
45378 describes a diagnostic colonoscopy without a therapeutic intervention. Balloon dilation during the colonoscopy points to 45386 instead.
$457.42–$501.06
45380 describes colonoscopy with biopsy, not balloon treatment of a narrowing. If both services are performed, account for CMS endoscopy family pricing.
Compare 45386 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$692.91
Facility
$207.52
East St. Louis →
Office / nonfacility
$642.64
Facility
$198.30
Rest Of Illinois →
Office / nonfacility
$632.28
Facility
$191.32
Suburban Chicago →
Office / nonfacility
$696.95
Facility
$200.93
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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 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.
5,51845382,,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
5,52045385,,Colonoscopy w/lesion removal,A,,4.46,10.00,,1.72,,0.51,14.97,6.69,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52145386,,Colonoscopy w/balloon dilat,A,,3.68,15.95,,1.49,,0.44,20.07,5.61,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52245388,,Colonoscopy w/ablation,A,,4.76,74.26,,1.78,,0.60,79.62,7.14,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52345389,,Colonoscopy w/stent plcmt,A,,5.11,1.89,NA,1.89,,0.58,7.58,7.58,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52445390,,Colonoscopy w/resection,A,,5.89,2.15,NA,2.15,,0.65,8.69,8.69,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00