How much does Medicare pay for CPT 45390?

Medicare allowed an average of $582.65 per service and paid $475.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1929.75, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45390?

Removal of large bowel tissue using a flexible endoscope. It was billed 21,478 times to 21,003 Medicare beneficiaries by 895 providers in 2024.

Does 45390 pay differently in an office than a hospital?

Yes. The allowed amount averaged $338.28 in an office setting and $587.06 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 45390 most?

Gastroenterology, with 15,333 services from 692 clinicians. Next are Ambulatory Surgical Center, Internal Medicine, General Surgery.

CPT 45390

Removal of large bowel tissue using a flexible endoscope

$582.65Medicare-allowed amount per service, averaged across 21,478 services

Providers submitted

$1929.75

Asking price, not received

Medicare allowed

$582.65

The fee schedule figure

Medicare paid

$475.85

Balance is patient coinsurance

Providers submitted an average of $1929.75 for this code and Medicare allowed $582.65 — 3.3× 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 $475.85 (82%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $338.28
Hospital / facility: $587.06

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 381 services were billed in an office setting and 21,097 in a facility.

Services: 21,478
Beneficiaries: 21,003
Providers billing it: 895
Total allowed: $12,514,157

What Medicare pays for CPT 45390

Across 21,478 services billed by 895 providers to 21,003 beneficiaries, Medicare allowed an average of $582.65 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 45390

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	15,333	14,947	$327.35	692
Ambulatory Surgical Center	5,114	5,055	$1400.69	155
Internal Medicine	770	745	$324.28	35
General Surgery	122	121	$311.56	6
Colorectal Surgery (Proctology)	96	92	$313.65	5
Hospitalist	43	43	$321.06	2

45390 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	4,409	$792.45	$518.40	136
Florida	1,897	$585.96	$497.35	81
New Jersey	986	$694.27	$538.31	39
North Carolina	973	$683.66	$616.70	39
Pennsylvania	944	$455.33	$372.04	47
Maryland	912	$641.67	$552.21	26
Virginia	871	$435.12	$362.40	33
Texas	832	$408.27	$340.47	48
New York	778	$423.88	$308.70	38
Washington	747	$661.69	$531.98	34
Illinois	723	$399.69	$302.44	35
Indiana	599	$486.49	$413.36	22
Massachusetts	577	$417.87	$319.80	27
Ohio	534	$492.24	$416.38	31
South Carolina	459	$386.22	$330.60	17
Colorado	372	$686.91	$565.92	13
Missouri	350	$350.32	$294.28	18
Iowa	339	$567.45	$510.84	8
Kansas	329	$611.62	$532.30	17
Kentucky	320	$520.36	$443.32	12
Georgia	316	$587.15	$502.64	17
Arizona	294	$545.83	$457.93	12
Michigan	282	$458.95	$358.57	13
Minnesota	272	$467.67	$375.25	11
Arkansas	220	$551.96	$496.43	12
Louisiana	205	$670.49	$597.88	11
Wisconsin	193	$465.39	$410.23	13
Tennessee	192	$308.63	$256.84	9
Nebraska	180	$551.55	$465.47	6
South Dakota	154	$552.43	$491.81	7
Connecticut	150	$638.32	$482.68	10
North Dakota	131	$307.93	$264.50	3
Mississippi	127	$671.01	$635.16	7
Oklahoma	125	$551.71	$472.76	5
Oregon	123	$705.02	$558.46	7
New Hampshire	114	$651.86	$545.55	5
West Virginia	107	$319.71	$245.81	5
Maine	77	$313.25	$263.26	4
Delaware	54	$319.86	$245.95	3
District of Columbia	46	$369.77	$254.60	2
New Mexico	34	$316.47	$262.39	2
Montana	30	$668.28	$573.91	2
Vermont	26	$307.48	$263.05	2
Utah	26	$314.99	$238.19	2
Idaho	14	$298.22	$268.86	1
Nevada	12	$315.35	$250.58	1
Hawaii	12	$323.53	$266.36	1
Alabama	11	$320.48	$256.79	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
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.