How much does Medicare pay for CPT 45381?

Medicare allowed an average of $181.72 per service and paid $149.82 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1998.71, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45381?

Injection beneath lining of large bowel using a flexible endoscope. It was billed 37,052 times to 36,577 Medicare beneficiaries by 1,588 providers in 2024.

Does 45381 pay differently in an office than a hospital?

Yes. The allowed amount averaged $86.87 in an office setting and $185.33 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 45381 most?

Ambulatory Surgical Center, with 18,069 services from 666 clinicians. Next are Gastroenterology, Internal Medicine, General Surgery.

CPT 45381

Injection beneath lining of large bowel using a flexible endoscope

$181.72Medicare-allowed amount per service, averaged across 37,052 services

Providers submitted

$1998.71

Asking price, not received

Medicare allowed

$181.72

The fee schedule figure

Medicare paid

$149.82

Balance is patient coinsurance

Providers submitted an average of $1998.71 for this code and Medicare allowed $181.72 — 11.0× 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 $149.82 (82%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $86.87
Hospital / facility: $185.33

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,358 services were billed in an office setting and 35,694 in a facility.

Services: 37,052
Beneficiaries: 36,577
Providers billing it: 1,588
Total allowed: $6,733,089

What Medicare pays for CPT 45381

Across 37,052 services billed by 1,588 providers to 36,577 beneficiaries, Medicare allowed an average of $181.72 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 45381

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	18,069	17,865	$348.45	666
Gastroenterology	17,101	16,864	$23.02	817
Internal Medicine	909	889	$22.99	50
General Surgery	590	583	$22.94	32
Colorectal Surgery (Proctology)	267	260	$26.42	16
Hospitalist	88	88	$15.22	5
Family Practice	16	16	$15.12	1
Thoracic Surgery	12	12	$14.30	1

45381 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	6,202	$226.30	$144.92	216
Florida	2,826	$202.99	$174.39	118
Texas	2,799	$185.37	$156.19	130
New York	2,166	$196.34	$131.07	94
Maryland	1,970	$191.18	$153.62	56
Illinois	1,699	$119.68	$94.57	75
New Jersey	1,423	$241.37	$185.31	69
Arizona	1,329	$182.52	$151.08	45
Pennsylvania	1,156	$203.73	$173.17	59
Georgia	880	$179.68	$151.15	47
Ohio	795	$152.92	$134.67	46
Mississippi	789	$151.67	$140.93	28
Virginia	775	$112.88	$84.26	37
Washington	768	$211.27	$162.23	37
Colorado	723	$196.44	$163.86	26
North Carolina	668	$205.67	$178.89	33
Indiana	666	$135.66	$111.15	35
Missouri	599	$124.13	$104.16	36
South Carolina	588	$155.92	$133.86	28
Louisiana	557	$175.87	$159.49	17
Massachusetts	487	$145.53	$111.06	26
Hawaii	433	$183.84	$128.37	9
Kansas	424	$127.98	$111.56	13
Delaware	422	$155.98	$120.81	13
Minnesota	416	$108.26	$83.36	17
Michigan	415	$197.38	$168.72	22
Alabama	398	$146.46	$137.59	19
Wisconsin	381	$112.54	$90.24	19
Tennessee	381	$178.89	$162.22	18
Oklahoma	354	$127.01	$108.15	17
Iowa	306	$192.05	$170.71	16
Nevada	302	$246.70	$198.75	15
New Hampshire	298	$107.61	$88.64	12
Kentucky	282	$93.73	$77.71	17
Montana	269	$82.49	$69.41	11
Arkansas	252	$164.03	$144.21	16
Idaho	234	$104.38	$86.32	11
Alaska	233	$238.28	$154.12	9
Oregon	222	$161.58	$119.21	13
South Dakota	218	$84.25	$71.17	8
Connecticut	185	$221.34	$174.77	11
Nebraska	153	$182.39	$154.53	8
North Dakota	136	$22.93	$13.07	7
New Mexico	129	$214.33	$182.73	7
Wyoming	94	$53.55	$40.03	4
Rhode Island	79	$237.47	$192.54	6
West Virginia	61	$14.83	$6.09	4
Maine	27	$22.21	$12.05	2
Vermont	25	$14.62	$6.16	2
District of Columbia	24	$16.20	$6.26	2
ZZ	21	$14.21	$6.23	1
Utah	13	$14.67	$6.28	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
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.