No office rate
45391 describes colonoscopy with EUS but without the needle aspiration or biopsy. Choose 45392 when EUS guides needle sampling of a target.
On this page
CMS RVU26D · Effective 2026-10-01
45392 Colonoscopy with EUS Medicare reimbursement rates in Utah
Reports colonoscopy with endoscopic ultrasound-guided needle aspiration or biopsy to sample a lesion within or beyond the bowel wall. Compare 45392 office and facility rates across CMS payment localities in Utah.
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 45392 in Utah?
Utah 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
No supported rate
Facility setting
$259.80
1 of 1 localities have a supported rate.
Payment area: Utah
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 45392: Colonoscopy with EUS-guided needle sampling
Reports colonoscopy with endoscopic ultrasound-guided needle aspiration or biopsy to sample a lesion within or beyond the bowel wall.
A gastroenterologist advances a colonoscope and uses endoscopic ultrasound to identify a target in or near the colorectal wall, then guides a needle through the endoscope to obtain a sample. Typical targets include subepithelial lesions or nearby structures such as perirectal lymph nodes. The service may be performed in a hospital or ambulatory endoscopy center, with the needle specimen sent for pathology or cytology review.
Report this code when the colonoscopic EUS examination includes ultrasound-guided intramural or transmural fine needle aspiration or biopsy; documentation should identify the target, ultrasound guidance, needle sampling, and specimen obtained. It is distinct from EUS without needle sampling and from forceps biopsy of the mucosal surface. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing governs payment. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 45392
- 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 RVU5.36 · 67%
- Practice expense (office) RVU1.99 · 25%
- Malpractice RVU0.61 · 8%
111
Medicare services in 2024 · #4800 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.
45392 compared with similar codes
Office rates for Utah, from the same CMS release.
$457.54
45380 is for forceps biopsy of colorectal mucosa. 45392 is for needle sampling guided by endoscopic ultrasound, including targets within or beyond the bowel wall.
No office rate
Both involve EUS-guided needle sampling, but 43242 is performed through an upper-GI endoscope for an upper-GI target; 45392 uses a colonoscope for a colorectal or nearby target.
Compare 45392 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
Utah →
Office / nonfacility
Unavailable
Facility
$259.80
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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 45392 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,526
- Code
- 45392
- Physician work
- 5.36
- Practice expense
- 1.99
- Malpractice
- 0.61
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.36 | × 1.000 | 5.3600 |
| Practice expense | 1.99 | × 0.940 | 1.8706 |
| Malpractice | 0.61 | × 0.898 | 0.5478 |
| Total RVUs | 7.7784 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$259.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.36 | 1 |
| Practice expense | 1.99 | 0.94 |
| Malpractice | 0.61 | 0.898 |
(5.36 × 1 + 1.99 × 0.94 + 0.61 × 0.898) × $33.4009 = $259.80
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.
45392 billing questions
How does this differ from 45391?
45392 includes EUS-guided fine needle aspiration or biopsy. Use 45391 for colonoscopy with EUS when needle sampling is not performed.
Can 45380 also be reported for the needle specimen?
The EUS-guided needle sampling is part of 45392, not a separate forceps biopsy. A separately performed mucosal biopsy is a different service and should be supported by distinct documentation.
What documentation supports 45392?
Document the endoscopic ultrasound findings, the target's location, needle guidance, sampling performed, and the specimen obtained. The record should distinguish needle sampling from a surface biopsy.
How are related endoscopies paid when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together, so payment follows the family pricing rules rather than treating every related procedure as an independent full service.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for it under the statutory restriction.
Can co-surgeons or a surgical team report this service?
Co-surgeons and team surgery are not permitted for this code under the CMS rules.
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.
5,52345389,,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
5,52545391,,Colonoscopy w/endoscope us,A,,4.52,1.76,NA,1.76,,0.49,6.77,6.77,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52645392,,Colonoscopy w/endoscopic fnb,A,,5.36,1.99,NA,1.99,,0.61,7.96,7.96,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52745393,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985