Billing code 45398: ColonoscopyMedicare rate & RVUs in Virginia
Reports colonoscopy with endoscopic band ligation of hemorrhoids when the intervention is performed during examination of the colon.
Medicare pays $883.93–$1,044.85 for 45398 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. 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 45398 covers
A gastroenterologist, colorectal surgeon, or other qualified endoscopist performs a colonoscopy and places bands endoscopically to treat hemorrhoidal tissue, commonly internal hemorrhoids. The colonoscope is used to reach and treat the target during the same procedure; this is distinct from band ligation performed through a sigmoidoscope, which examines a shorter portion of the bowel.
Report this code when the colonoscopy includes hemorrhoid band ligation, and document the examination, hemorrhoid treatment, and procedure performed. A diagnostic inspection during the same session is part of the therapeutic colonoscopy rather than a separate diagnostic colonoscopy claim. The service has 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. CMS 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 45398 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $1,044.85 | $228.42 |
| Virginia | $883.93 | $202.64 |
How the 45398 rate is calculated
Each of 45398’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 · 45398
RVUs × geographic indexes × conversion factor
Work4.10
4.10 RVUs× 1.000 GPCI
Practice expense22.32
22.32 RVUs× 1.000 GPCI
Malpractice0.60
0.60 RVUs× 1.000 GPCI
Adjusted RVUs
27.0200
Conversion factor
$33.4009
Medicare rate
$902.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45398
The CMS indicators that decide how 45398 is paid alongside other services.
CMS payment indicators · 45398
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
45398 without 51 · national office
$902.49
Colonoscopy
45398-51 · Second procedure: 50%
$451.25
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%).
45398 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45350Sigmoidoscopy
- Both involve endoscopic band ligation, but 45398 is performed during colonoscopy; 45350 is performed during sigmoidoscopy.
- 45378Colonoscopy
- 45378 describes diagnostic colonoscopy without the band-ligation intervention. Use 45398 when hemorrhoid band ligation is performed during the colonoscopy.
- 45382Colonoscopy
- 45382 is for endoscopic control of bleeding. 45398 is specific to colonoscopy with hemorrhoid band ligation.
45398 billing questions
When should 45398 be selected instead of 45350?
Use 45398 when the band ligation is performed during colonoscopy. Use 45350 when the procedure is performed with a sigmoidoscope rather than a colonoscope.
Can the diagnostic colonoscopy be reported separately?
Do not separately report a diagnostic colonoscopy for the inspection that is part of the same therapeutic colonoscopy with band ligation.
How are related endoscopies handled in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document the procedures performed during the session.
Should modifier 50 be appended for multiple hemorrhoids?
No. CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant, co-surgeon, or surgical team be billed?
CMS does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure.
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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