How much does Medicare pay for CPT 45378?

Medicare allowed an average of $260.72 per service and paid $200.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1499.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45378?

Diagnostic exam of large bowel using a flexible endoscope. It was billed 237,385 times to 235,118 Medicare beneficiaries by 8,154 providers in 2024.

Does 45378 pay differently in an office than a hospital?

Yes. The allowed amount averaged $305.71 in an office setting and $258.75 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 45378 most?

Gastroenterology, with 138,452 services from 5,458 clinicians. Next are Ambulatory Surgical Center, General Surgery, Internal Medicine.

CPT 45378

Diagnostic exam of large bowel using a flexible endoscope

$260.72Medicare-allowed amount per service, averaged across 237,385 services

Providers submitted

$1499.56

Asking price, not received

Medicare allowed

$260.72

The fee schedule figure

Medicare paid

$200.94

Balance is patient coinsurance

Providers submitted an average of $1499.56 for this code and Medicare allowed $260.72 — 5.8× 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 $200.94 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $305.71
Hospital / facility: $258.75

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. 9,998 services were billed in an office setting and 227,387 in a facility.

Services: 237,385
Beneficiaries: 235,118
Providers billing it: 8,154
Total allowed: $61,891,017

What Medicare pays for CPT 45378

Across 237,385 services billed by 8,154 providers to 235,118 beneficiaries, Medicare allowed an average of $260.72 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 45378

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	138,452	136,931	$179.36	5,458
Ambulatory Surgical Center	69,196	68,720	$459.93	1,339
General Surgery	14,784	14,662	$167.04	704
Internal Medicine	9,028	8,920	$184.18	372
Colorectal Surgery (Proctology)	4,682	4,654	$185.75	225
Family Practice	288	287	$179.68	16
Hospitalist	192	189	$165.49	10
Emergency Medicine	164	163	$173.15	6
Thoracic Surgery	104	104	$164.62	3
General Practice	84	79	$159.80	5
Pediatric Medicine	71	71	$257.08	3
Anesthesiology	59	58	$286.76	2
Gynecological Oncology	55	55	$192.39	1
Osteopathic Manipulative Medicine	53	53	$161.24	2
Nephrology	53	53	$300.21	1

45378 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	26,414	$298.58	$203.05	771
New York	22,635	$300.78	$202.91	635
Florida	19,386	$268.59	$214.35	605
Texas	13,901	$256.67	$208.01	493
Pennsylvania	9,373	$258.12	$203.68	380
Illinois	9,178	$241.56	$183.51	339
New Jersey	9,013	$293.14	$209.80	301
Maryland	8,009	$287.18	$220.34	228
Georgia	7,886	$252.33	$202.46	278
Ohio	7,844	$235.61	$192.58	330
North Carolina	7,475	$256.04	$211.90	265
Massachusetts	6,348	$223.46	$163.14	217
South Carolina	6,275	$252.37	$208.71	169
Tennessee	5,951	$231.98	$196.81	200
Arizona	5,336	$285.13	$222.78	167
Virginia	5,139	$229.80	$170.40	200
Michigan	4,628	$236.73	$185.94	192
Alabama	4,591	$217.18	$190.30	153
Missouri	4,283	$219.94	$175.94	180
Mississippi	3,875	$238.95	$210.10	101
Indiana	3,667	$217.21	$176.92	166
Louisiana	3,590	$238.08	$203.04	126
Arkansas	3,213	$237.20	$201.67	93
Kentucky	3,127	$198.22	$161.05	136
Kansas	3,101	$226.53	$185.82	105
Oklahoma	2,925	$224.42	$179.36	104
Nevada	2,883	$303.72	$231.91	71
Connecticut	2,338	$285.64	$205.92	99
Washington	2,323	$273.98	$206.24	110
Colorado	2,205	$265.73	$206.18	100
Delaware	1,770	$271.87	$210.26	43
West Virginia	1,506	$177.32	$137.78	58
Wisconsin	1,494	$203.93	$162.22	76
Iowa	1,436	$230.70	$193.16	65
Oregon	1,320	$293.96	$218.42	57
Nebraska	1,225	$234.51	$189.76	51
New Hampshire	1,194	$202.64	$152.45	50
Utah	1,083	$212.90	$167.09	43
Minnesota	1,075	$238.39	$181.60	56
South Dakota	1,042	$239.53	$196.03	28
New Mexico	1,015	$238.32	$187.17	34
Rhode Island	978	$268.92	$214.03	37
Hawaii	787	$331.08	$235.94	28
Idaho	766	$230.31	$189.94	37
Alaska	762	$340.93	$212.80	33
Montana	636	$199.78	$151.05	29
District of Columbia	494	$223.39	$154.76	25
North Dakota	475	$175.29	$139.15	15
Maine	405	$195.67	$153.10	24
Vermont	342	$239.22	$186.32	13
Wyoming	337	$233.42	$185.35	16
Puerto Rico	260	$285.40	$222.38	18
Guam	51	$210.49	$160.62	3
U.S. Virgin Islands	20	$172.03	$124.03	1

Related codes

45385Removal of polyps or growths of large bowel$362.33
45380Biopsy of large bowel$242.88
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
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.