CPT Code 45380
Colonoscopy with tissue biopsy of the colon lining
Source: CMS 2026 Physician Fee Schedule. Maintained by the D3rx Clinical Billing Team.
2026 Medicare national rate
Office (non-facility)
$479.97
Performed in a physician office
Facility
$177.69
Hospital / ASC setting
Total RVUs (office)
14.37
5.32 facility
Conversion factor
$33.4009
2026 PFS
Medicare payment = total RVUs × GPCI (locality adjustment) × conversion factor. At the national level (GPCI = 1.0), 14.37 × 33.4009 = $479.97 (office). Facility rates are lower because the facility separately bills its overhead.
RVU breakdown
Work RVU
3.47
Office PE RVU
10.48
Facility PE RVU
1.43
Malpractice RVU
0.42
PC/TC: Physician service — not subject to a professional/technical split.
Billing notes
- Medicare pays $302.28 more for 45380 in an office ($479.97) than in a facility ($177.69). The office (non-facility) rate carries the practice-expense overhead a hospital or ASC bills separately, so the place-of-service code you submit directly changes the allowable.
- 45380 has a 0-day global period, so a separately identifiable E/M on the same day may be reported with modifier 25 when the documentation supports it.
- The national allowable is built from 14.37 total office RVUs × the $33.4009 conversion factor; multiply by your locality GPCIs (above) to reconcile a specific remittance.
Billing & payment rules
- Multiple procedures
- Special endoscopic multiple-procedure rules apply.
- Assistant surgeon
- Assistant surgeon may not be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgeons
- Team surgeons not permitted.
- Global period
- 0-day global period — no built-in postoperative period; a separately identifiable same-day E/M (modifier 25) may be billable.
2026 rate by locality
| Locality | Office | Facility |
|---|---|---|
| National (GPCI 1.0) | $479.97 | $177.69 |
| Manhattan, NY | $552.32 | $201.07 |
| Los Angeles, CA | $544.07 | $186.47 |
| Houston, TX | $483.72 | $183.56 |
| Chicago, IL | $500.70 | $196.91 |
| Miami, FL | $515.77 | $201.10 |
| Atlanta, GA | $488.74 | $181.62 |
Computed from CMS 2026 GPCIs: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009. Your MAC's locality may differ.
Related Surgery codes
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Medical billing disclaimer
Rates shown are 2026 Medicare Physician Fee Schedule amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.