Billing code 45391: Colonoscopy EUSMedicare rate & RVUs in Washington
Reports a full colonoscopy with endoscopic ultrasound to assess bowel-wall lesions, rectal abnormalities, or nearby structures without EUS-guided tissue sampling.
CMS doesn’t publish an office rate for 45391 in Washington.
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 45391 covers
A gastroenterologist or other qualified endoscopist advances a colonoscope to examine the colon and uses an ultrasound transducer during the procedure to assess bowel-wall layers and adjacent anatomy. Common reasons include evaluating a subepithelial lesion, characterizing a rectal mass, or assessing local rectal cancer extent. The procedure is typically performed in a hospital endoscopy unit or ambulatory endoscopy center.
Select this code when the colonoscopy includes endoscopic ultrasound examination without ultrasound-guided needle sampling; when EUS guides fine-needle aspiration or biopsy, compare 45392. The report should identify the findings and document the ultrasound examination. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare 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 45391 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $227.29 |
| Seattle (King Cnty) | Unavailable | $244.02 |
How the 45391 rate is calculated
Each of 45391’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 · 45391
RVUs × geographic indexes × conversion factor
Work4.52
4.52 RVUs× 1.000 GPCI
Practice expense1.76
1.76 RVUs× 1.000 GPCI
Malpractice0.49
0.49 RVUs× 1.000 GPCI
Adjusted RVUs
6.7700
Conversion factor
$33.4009
Medicare rate
$226.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45391
The CMS indicators that decide how 45391 is paid alongside other services.
CMS payment indicators · 45391
Colonoscopy EUS
| 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
45391 without 51 · national facility
$226.12
Colonoscopy EUS
45391-51 · Second procedure: 50%
$113.06
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%).
45391 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45392Colonoscopy with EUS
- Choose 45391 for colonoscopy with EUS examination alone. Choose 45392 when EUS guides fine-needle aspiration or biopsy.
- 45341Sigmoidoscopy ultrasound
- 45341 is sigmoidoscopy with ultrasound, while 45391 describes colonoscopy with ultrasound. Select based on the scope examination performed.
- 45342Sigmoidoscopy
- 45342 combines sigmoidoscopy, ultrasound, and ultrasound-guided biopsy; 45391 is the colonoscopy EUS examination without that guided sampling.
- 45378Colonoscopy
- 45378 is diagnostic colonoscopy without EUS. Use 45391 when endoscopic ultrasound is also performed during the colonoscopy.
45391 billing questions
When should 45392 be used instead?
Use 45392 when endoscopic ultrasound guides fine-needle aspiration or biopsy. Code 45391 describes the ultrasound examination without that guided tissue-sampling service.
Can diagnostic colonoscopy 45378 also be reported for the same session?
The diagnostic inspection that is part of the same colonoscopy is included; do not separately report 45378 for that same examination.
How does 45391 differ from sigmoidoscopy with ultrasound?
45391 describes colonoscopy with EUS. For an examination limited to the sigmoid colon or rectum, compare the sigmoidoscopy ultrasound code 45341.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy does not support bilateral reporting.
What happens when related endoscopies are performed in the same session?
CMS applies endoscopy family pricing to related endoscopies performed together. The claim should reflect the procedures actually performed, with payment determined under that family rule.
What documentation supports reporting 45391?
Document the colonoscopy, the endoscopic ultrasound examination, the anatomy assessed, and the findings. If EUS-guided needle sampling was performed, evaluate 45392 instead.
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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