Endoscopy

45380 - RVUs & Medicare payment (2026)

Colonoscopy with biopsy.

Component	Non-facility	Facility
Work RVU	3.47	3.47
Practice expense RVU	10.48	1.43
Malpractice RVU	0.42	0.42
Total RVUs	14.37	5.32
National payment (CF $33.4009)	$479.97	$177.69
Qualifying APM payment (CF $33.5675)	$482.36	$178.58

How 45380 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 45380 ranges from $423.81 in Arkansas (AR) to $640.93 in San Jose-Sunnyvale-Santa Clara (CA); calculate 45380 for your locality.

San Jose-Sunnyvale-Santa Clara (CA) $640.93 San Jose-Sunnyvale-Santa Clara (CA) $638.98 San Francisco-Oakland-Berkeley (CA) $626.91 San Francisco-Oakland-Berkeley (CA) $626.43 Napa (CA) $591.68 Vallejo (CA) $591.00 NYC Suburbs/Long Island (NY) $565.57 Seattle (WA) $562.66 National average $479.97 … 97 more localities between … Rest Of Missouri (MO) $431.30 Alabama (AL) $430.13 Mississippi (MS) $427.65 Arkansas (AR) $423.81

Non-facility payment for 45380 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: 000

Same-day global period: related visits on the day of the procedure are included in the payment.

Related codes - endoscopy

43239 · upper gi endoscopy with biopsy
45378 · colonoscopy, diagnostic
45385 · colonoscopy with snare polypectomy
G0121 · screening colonoscopy, not high risk (medicare)
G0105 · screening colonoscopy, high risk (medicare)
52000 · cystourethroscopy, diagnostic

Frequently asked questions

How much does Medicare pay for 45380 in 2026?

The national non-facility payment is $479.97 and the facility payment is $177.69, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 45380?

The 2026 work RVU for 45380 is 3.47. Total RVUs are 14.37 in the non-facility setting and 5.32 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.