How much does Medicare pay for CPT 45300?

Medicare allowed an average of $116.96 per service and paid $87.61 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $368.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45300?

Diagnostic exam of rectum and lower large bowel using an endoscope. It was billed 9,408 times to 8,019 Medicare beneficiaries by 207 providers in 2024.

Does 45300 pay differently in an office than a hospital?

Yes. The allowed amount averaged $127.74 in an office setting and $35.35 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 45300 most?

Colorectal Surgery (Proctology), with 7,561 services from 162 clinicians. Next are General Surgery, Radiation Oncology, Physician Assistant.

CPT 45300

Diagnostic exam of rectum and lower large bowel using an endoscope

$116.96Medicare-allowed amount per service, averaged across 9,408 services

Providers submitted

$368.26

Asking price, not received

Medicare allowed

$116.96

The fee schedule figure

Medicare paid

$87.61

Balance is patient coinsurance

Providers submitted an average of $368.26 for this code and Medicare allowed $116.96 — 3.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $87.61 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $127.74
Hospital / facility: $35.35

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 8,310 services were billed in an office setting and 1,098 in a facility.

Services: 9,408
Beneficiaries: 8,019
Providers billing it: 207
Total allowed: $1,100,360

What Medicare pays for CPT 45300

Across 9,408 services billed by 207 providers to 8,019 beneficiaries, Medicare allowed an average of $116.96 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 45300

Specialty	Services	Beneficiaries	Avg allowed	Providers
Colorectal Surgery (Proctology)	7,561	6,437	$121.15	162
General Surgery	1,336	1,142	$108.61	30
Radiation Oncology	182	132	$29.18	3
Physician Assistant	126	111	$93.11	2
Internal Medicine	108	108	$132.94	4
Surgical Oncology	34	28	$91.00	2
Nurse Practitioner	19	19	$99.04	1
Ambulatory Surgical Center	18	18	$72.54	1
Emergency Medicine	13	13	$21.56	1
Gastroenterology	11	11	$118.63	1

45300 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,116	$109.84	$75.02	36
New York	1,724	$121.52	$79.19	34
Texas	800	$122.93	$90.72	22
New Jersey	608	$125.78	$84.10	13
Maryland	583	$140.61	$90.58	4
Pennsylvania	541	$122.35	$86.65	12
Tennessee	311	$105.73	$86.84	7
Arizona	267	$108.78	$87.58	4
Kentucky	238	$115.46	$96.64	6
Nebraska	236	$106.93	$83.94	5
Ohio	195	$117.93	$93.18	4
Missouri	192	$119.09	$95.45	3
Florida	187	$115.00	$88.90	7
Washington	156	$129.90	$87.67	5
Kansas	150	$114.98	$94.02	2
North Carolina	137	$98.94	$75.60	7
Iowa	125	$114.78	$94.25	5
Oregon	119	$126.80	$89.87	4
South Carolina	103	$121.14	$93.94	4
Nevada	88	$80.84	$62.95	2
Wisconsin	82	$43.61	$34.55	1
Georgia	56	$112.64	$88.65	2
Arkansas	40	$110.47	$92.18	1
Connecticut	40	$139.25	$94.79	1
Alabama	38	$80.59	$66.45	2
District of Columbia	37	$142.44	$93.67	1
Colorado	31	$122.08	$88.86	1
Illinois	30	$30.76	$18.78	2
Massachusetts	27	$134.46	$88.23	2
Alaska	26	$144.82	$88.25	1
Delaware	24	$125.05	$77.29	1
Puerto Rico	23	$126.34	$95.83	1
Virginia	21	$115.25	$98.80	1
Hawaii	16	$124.73	$87.36	1
Oklahoma	15	$118.94	$88.23	1
Idaho	14	$43.53	$35.12	1
Michigan	12	$25.00	$18.75	1

Related codes

45385Removal of polyps or growths of large bowel$362.33
45380Biopsy of large bowel$242.88
45378Diagnostic exam of large bowel$260.72
45384Removal of polyps or growths of large bowel$277.07
45381Injection beneath lining of large bowel$181.72
45390Removal of large bowel tissue$582.65
45330Diagnostic exam of lower portion of large bowel$98.83
45388Destruction of polyp or growth of large bowel$491.91
45331Biopsy of lower large bowel$291.11
45382Control of bleeding of upper large bowel$290.18
45398Banding of hemorrhoids$404.14

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.