What documentation does 45378 require?

- Indication. - Sedation, prep quality (BBPS). - Cecum or terminal ileum reached. - Withdrawal time ≥6 minutes.

What are common 45378 billing pitfalls?

- If any biopsy taken, use 45380 instead.

How much does 45378 pay in 2026?

2026 work RVU for 45378 is 3.36. National Medicare non-facility allowable is approximately $287.92 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

GI · CMS status A

45378

Diagnostic colonoscopy

Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing.

Model in calculator →Audit a note

Work RVU

3.36

2026 Medicare pays

$287.92

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 3.36 + Practice 4.92 + Malpractice 0.34 = 8.62 total

Work (your effort)Practice expenseMalpractice

When to use it

Diagnostic colonoscopy (symptoms, surveillance) without biopsy or therapeutic intervention.

Documentation checklist

✓Indication.
✓Sedation, prep quality (BBPS).
✓Cecum or terminal ileum reached.
✓Withdrawal time ≥6 minutes.
✓Findings and photo documentation.

Common pitfalls

!If any biopsy taken, use 45380 instead.

Common ICD-10 pairings

K92.1K59.00

Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.