$449.63
Use 45380 when tissue is sampled for biopsy. Use 45378 when the exam is diagnostic and no tissue biopsy is performed.
On this page
CMS RVU26D · Effective 2026-10-01
45378 Colonoscopy Medicare reimbursement rates in Ohio
Reports a diagnostic examination of the colon when the endoscopist inspects the colon without performing a separately described biopsy or therapeutic intervention. Compare 45378 office and facility rates across CMS payment localities in Ohio.
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 45378 in Ohio?
Ohio 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
$355.75
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$160.88
1 of 1 localities have a supported rate.
Payment area: Ohio
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 procedure
About 45378: Diagnostic full-colon endoscopic examination
Reports a diagnostic examination of the colon when the endoscopist inspects the colon without performing a separately described biopsy or therapeutic intervention.
A gastroenterologist or colorectal surgeon advances a flexible endoscope through the colon to examine the bowel, commonly for evaluation of symptoms or an abnormal finding. The service can include specimen collection by brushing or washing, but it does not describe taking tissue for biopsy or treating a lesion. It is typically performed in an endoscopy unit or hospital outpatient department, with sedation commonly provided as part of the procedural setting.
Choose this code when the documented service is diagnostic inspection rather than a more specific colonoscopy procedure. The report should support the examination performed and whether a biopsy or treatment was done; when a more specific procedure is performed, report that service rather than separately reporting the diagnostic examination. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Modifier 53 is separately priced. Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
CMS billing rules for 45378
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- 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 RVU3.18 · 28%
- Practice expense (office) RVU7.73 · 68%
- Malpractice RVU0.41 · 4%
303.1K
Medicare services in 2024 · #309 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.
45378 compared with similar codes
Office rates for Ohio, from the same CMS release.
$471.09
Use 45385 when a lesion is removed by snare. Diagnostic inspection alone is reported with 45378.
$199.15
45330 describes diagnostic flexible sigmoidoscopy of a limited portion of the lower bowel; 45378 is for a colonoscopy.
$451.28
45379 applies when a foreign body is removed during colonoscopy. Without that removal or another therapeutic procedure, the diagnostic service is 45378.
Compare 45378 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
Ohio →
Office / nonfacility
$355.75
Facility
$160.88
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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 45378 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,513
- Code
- 45378
- Physician work
- 3.18
- Practice expense
- 7.73
- Malpractice
- 0.41
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.18 | × 1.000 | 3.1800 |
| Practice expense | 7.73 | × 0.913 | 7.0575 |
| Malpractice | 0.41 | × 1.008 | 0.4133 |
| Total RVUs | 10.6508 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$355.75
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.18 | 1 |
| Practice expense | 7.73 | 0.913 |
| Malpractice | 0.41 | 1.008 |
(3.18 × 1 + 7.73 × 0.913 + 0.41 × 1.008) × $33.4009 = $355.75
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.18 | 1 |
| Practice expense | 1.34 | 0.913 |
| Malpractice | 0.41 | 1.008 |
(3.18 × 1 + 1.34 × 0.913 + 0.41 × 1.008) × $33.4009 = $160.88
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.
45378 billing questions
When should 45378 be chosen instead of 45380?
Use 45378 for diagnostic inspection without tissue biopsy. When tissue is sampled for histologic examination, report the biopsy service, 45380, instead.
Can 45378 be reported with a colonoscopy that removes a polyp?
The diagnostic inspection is part of the colonoscopy with polyp removal; report the code for the removal method rather than separately billing 45378 for the same examination.
Is modifier 50 appropriate for 45378?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How should modifier 53 be handled?
CMS lists modifier 53 as separately priced for 45378. The record should support that the colonoscopy was discontinued; apply the modifier only when the circumstances meet its reporting requirements.
Does the 0-day global period include same-day care?
Yes. Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
How many units are reported for the diagnostic examination?
Report one service for the colonoscopy, not a separate unit for each segment examined.
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.
5,51045347,,Sigmoidoscopy w/plcmt stent,A,,2.65,1.14,NA,1.14,,0.30,4.09,4.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,51145349,,Sigmoidoscopy w/resection,A,,3.43,1.43,NA,1.43,,0.39,5.25,5.25,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,51245350,,Sgmdsc w/band ligation,A,,1.64,20.41,,0.90,,0.21,22.26,2.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703