Billing code 45393: Colonic decompressionMedicare rate & RVUs in Illinois
Endoscopic colonic decompression relieves acute distention, sometimes with a decompression tube, and is reported when that therapeutic intervention is performed.
CMS doesn’t publish an office rate for 45393 in Illinois.
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 45393 covers
billing code 45393 represents flexible colonoscopy performed to relieve marked colonic distention by evacuating gas and fluid, with or without leaving a decompression tube. It is used in situations such as acute colonic pseudo-obstruction (Ogilvie syndrome) or selected volvulus cases when endoscopic decompression is chosen. A gastroenterologist or colorectal surgeon typically performs the procedure in a hospital or other endoscopy-capable facility, often for an acutely ill patient.
Report the code when decompression is the therapeutic purpose, not for routine diagnostic inspection alone. Documentation should identify the indication, procedure performed, whether a tube was placed, and the clinical response. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed in the same session, endoscopy-family pricing applies rather than pricing each as an unrelated procedure. Modifier 50 is inappropriate. Medicare does not pay an assistant-at-surgery claim for this procedure; co-surgeons and team surgeons 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 45393 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.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $243.97 |
| East St. Louis | Unavailable | $233.61 |
| Rest Of Illinois | Unavailable | $224.85 |
| Suburban Chicago | Unavailable | $235.23 |
How the 45393 rate is calculated
Each of 45393’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 · 45393
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.56Practice expense 1.42Malpractice 0.56
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45393
The CMS indicators that decide how 45393 is paid alongside other services.
CMS payment indicators · 45393
Colonic decompression
| 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
45393 without 51 · national facility
$218.44
Colonic decompression
45393-51 · Second procedure: 50%
$109.22
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%).
45393 compared with similar codes
Compare codes
45393 vs 45378 vs 45386 vs 45389 vs 45382: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45378Colonoscopy
- 45378 represents diagnostic colonoscopy. Choose 45393 when the procedure includes therapeutic decompression of the distended colon.
- 45386Colonoscopy
- 45386 is for balloon dilation of a colonic narrowing. It is not the decompression code when the therapeutic objective is relief of colonic distention.
- 45389Colonoscopy
- 45389 represents colonoscopic stent placement. Use 45393 for decompression when a stent is not the intervention performed.
- 45382Colonoscopy
- 45382 is for endoscopic control of bleeding. Use 45393 when colonic decompression, rather than hemostasis, is the therapeutic service.
45393 billing questions
When should 45393 be chosen instead of a diagnostic colonoscopy?
Use 45393 when the colonoscopy is performed therapeutically to decompress the colon, as in acute colonic pseudo-obstruction. A diagnostic examination without decompression is represented by 45378.
Is placement of a decompression tube separately reported?
Tube placement is included in 45393 when performed; the code also covers decompression without leaving a tube.
Can 45378 also be reported for the same procedure?
Do not separately report a diagnostic colonoscopy for the inspection that is part of the decompressive procedure.
How does Medicare price another endoscopy performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together, rather than pricing each as an unrelated full procedure.
Which surgical modifiers are appropriate for this service?
Modifier 50 is inappropriate. Medicare does not pay an assistant-at-surgery claim, and co-surgeon or team-surgery billing is 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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