How much does Medicare pay for CPT 45398?

Medicare allowed an average of $404.14 per service and paid $321.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2280.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 45398?

Banding of hemorrhoids using a flexible endoscope (colonoscope). It was billed 2,009 times to 1,997 Medicare beneficiaries by 65 providers in 2024.

Does 45398 pay differently in an office than a hospital?

Yes. The allowed amount averaged $667.45 in an office setting and $335.38 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 45398 most?

Gastroenterology, with 1,035 services from 23 clinicians. Next are Ambulatory Surgical Center, General Surgery, Colorectal Surgery (Proctology).

CPT 45398

Banding of hemorrhoids using a flexible endoscope (colonoscope)

$404.14Medicare-allowed amount per service, averaged across 2,009 services

Providers submitted

$2280.94

Asking price, not received

Medicare allowed

$404.14

The fee schedule figure

Medicare paid

$321.88

Balance is patient coinsurance

Providers submitted an average of $2280.94 for this code and Medicare allowed $404.14 — 5.6× 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 $321.88 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $667.45
Hospital / facility: $335.38

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. 416 services were billed in an office setting and 1,593 in a facility.

Services: 2,009
Beneficiaries: 1,997
Providers billing it: 65
Total allowed: $811,917

What Medicare pays for CPT 45398

Across 2,009 services billed by 65 providers to 1,997 beneficiaries, Medicare allowed an average of $404.14 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 45398

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	1,035	1,027	$327.28	23
Ambulatory Surgical Center	806	803	$547.17	31
General Surgery	91	91	$201.42	6
Colorectal Surgery (Proctology)	46	46	$211.00	3
Internal Medicine	31	30	$133.38	2

45398 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
Nebraska	453	$184.97	$152.07	2
California	428	$413.76	$283.51	11
Florida	275	$470.78	$393.92	14
Texas	259	$632.50	$536.68	5
Illinois	110	$519.91	$416.74	4
Maryland	65	$492.42	$397.00	4
Arizona	61	$385.81	$314.59	3
Michigan	47	$246.37	$205.11	3
South Carolina	44	$410.30	$344.90	2
Hawaii	39	$420.87	$316.31	2
Idaho	39	$208.01	$170.09	2
Alabama	32	$337.15	$333.61	2
Mississippi	32	$496.61	$480.81	2
Nevada	27	$353.09	$289.19	2
New York	27	$952.69	$655.70	2
New Mexico	19	$130.09	$101.71	1
New Jersey	14	$637.53	$492.74	1
Virginia	14	$576.37	$501.30	1
Utah	12	$578.76	$470.50	1
Tennessee	12	$210.43	$181.83	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
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

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.