How much does Medicare pay for CPT 45330?

Medicare allowed an average of $98.83 per service and paid $74.32 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $830.27, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45330?

Diagnostic exam of lower portion of large bowel using a flexible endoscope. It was billed 11,817 times to 10,393 Medicare beneficiaries by 548 providers in 2024.

Does 45330 pay differently in an office than a hospital?

Yes. The allowed amount averaged $151.32 in an office setting and $79.38 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 45330 most?

Colorectal Surgery (Proctology), with 4,951 services from 185 clinicians. Next are Ambulatory Surgical Center, Gastroenterology, General Surgery.

CPT 45330

Diagnostic exam of lower portion of large bowel using a flexible endoscope

$98.83Medicare-allowed amount per service, averaged across 11,817 services

Providers submitted

$830.27

Asking price, not received

Medicare allowed

$98.83

The fee schedule figure

Medicare paid

$74.32

Balance is patient coinsurance

Providers submitted an average of $830.27 for this code and Medicare allowed $98.83 — 8.4× 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 $74.32 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $151.32
Hospital / facility: $79.38

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. 3,195 services were billed in an office setting and 8,622 in a facility.

Services: 11,817
Beneficiaries: 10,393
Providers billing it: 548
Total allowed: $1,167,874

What Medicare pays for CPT 45330

Across 11,817 services billed by 548 providers to 10,393 beneficiaries, Medicare allowed an average of $98.83 per service. 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 45330

Specialty	Services	Beneficiaries	Avg allowed	Providers
Colorectal Surgery (Proctology)	4,951	3,994	$104.99	185
Ambulatory Surgical Center	3,327	3,222	$129.70	161
Gastroenterology	1,946	1,897	$57.27	132
General Surgery	1,182	955	$67.62	58
Surgical Oncology	279	202	$57.45	5
Internal Medicine	51	50	$51.95	4
Gynecological Oncology	47	46	$27.27	1
Vascular Surgery	23	16	$213.46	1
Thoracic Surgery	11	11	$30.25	1

45330 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
New York	1,309	$121.43	$78.89	43
Florida	1,143	$109.98	$87.00	57
California	1,036	$96.71	$63.86	46
Pennsylvania	876	$129.88	$93.54	32
Texas	601	$63.03	$48.99	27
Illinois	518	$79.24	$60.98	26
New Jersey	469	$159.58	$107.56	18
Massachusetts	446	$93.60	$64.13	21
Maryland	407	$105.66	$79.02	23
Louisiana	379	$77.25	$67.35	20
Ohio	362	$66.91	$55.72	18
Arizona	323	$89.66	$66.79	15
Virginia	312	$87.91	$62.24	15
Mississippi	275	$84.41	$74.83	12
Tennessee	251	$90.55	$74.83	11
Alabama	234	$66.97	$58.00	10
Indiana	231	$119.96	$95.82	14
Georgia	230	$73.02	$57.16	13
North Carolina	213	$113.12	$91.06	10
Nevada	184	$88.05	$68.17	7
Kansas	174	$121.48	$97.57	8
South Carolina	167	$77.08	$61.54	12
Missouri	159	$72.64	$58.42	9
Oklahoma	154	$141.77	$111.21	5
Arkansas	146	$62.88	$54.78	6
Washington	116	$93.63	$65.88	7
Minnesota	105	$113.83	$86.56	4
Vermont	92	$51.06	$37.61	4
Nebraska	81	$82.91	$68.15	4
Michigan	80	$71.17	$55.26	6
Colorado	73	$110.77	$87.38	4
Kentucky	71	$82.91	$65.61	4
New Hampshire	70	$53.84	$40.85	4
Connecticut	70	$53.21	$37.49	4
West Virginia	65	$43.50	$34.71	5
Oregon	60	$95.64	$65.81	4
District of Columbia	59	$68.51	$48.61	3
Iowa	59	$57.95	$46.34	4
Alaska	37	$106.89	$59.19	2
New Mexico	34	$94.42	$72.96	2
Wisconsin	26	$50.57	$39.92	1
Delaware	26	$96.94	$76.24	2
Puerto Rico	19	$183.63	$129.23	1
Rhode Island	17	$188.77	$135.62	1
Idaho	16	$46.05	$39.79	1
Utah	15	$52.86	$39.82	1
South Dakota	15	$49.28	$43.27	1
North Dakota	12	$39.15	$31.24	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
45388Destruction of polyp or growth of large bowel$491.91
45300Diagnostic exam of rectum and lower large bowel$116.96
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.