45385 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Colonoscopy w/lesion removal.
⚠️ This is a National Estimate
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Code Description
Colonoscopy w/lesion removal
Reimbursement Summary
For 2026, the estimated National Average Medicare payment for 45385 is $500.01 in a non-facility (office) setting and $223.45 in a facility (hospital/outpatient) setting. Your actual reimbursement depends on locality adjustments.
This code’s RVU components (Work, Practice Expense, and Malpractice) combine to approximately 14.97 total RVUs in the office setting and 6.69 total RVUs in the facility setting.
Description: Colonoscopy w/lesion removal. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $500.01 | $223.45 | +14.84% | -8.01% |
| 2026 Q1 | $500.01 | $223.45 | +14.84% | -8.01% |
| 2025 Q4 | $435.38 | $242.92 | — | — |
| 2025 Q3 | $435.38 | $242.92 | — | — |
| 2025 Q2 | $435.38 | $242.92 | — | — |
| 2025 Q1 | $435.38 | $242.92 | — | — |
Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 4.46 | 4.46 |
| Practice Expense (PE) | 10 | 1.72 |
| Malpractice (MP) | 0.51 | 0.51 |
| Total RVUs | 14.97 | 6.69 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 45385?
The 2026 National Average Medicare reimbursement rate for 45385 (Physician Service) is $500.01. This rate is effective as of January 1, 2026.
What is the description for code 45385?
Colonoscopy w/lesion removal
Why do facility and non-facility payments differ for 45385?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for 45385?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 45385 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.