# CPT 45378

> Medicare pays $378.10 for CPT 45378 in the office (non-facility) setting and $164.67 in a facility under the Q4 2026 Physician Fee Schedule, effective October 2026. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, the office amount is $335.05–$497.55 and the facility amount is $151.71–$214.53. This price has been unchanged since Q1 2026, when it increased 15.4%.

## What it is

Diagnostic Colonoscopy

## Selected release

- Release: Q4 2026 (2026 D)
- Effective: October 1 – December 31, 2026
- Status indicator: A
- Office (non-facility) national allowed amount: $378.10
- Facility national allowed amount: $164.67
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.18
- Office (non-facility) practice expense RVU: 7.73
- Facility practice expense RVU: 1.34
- Malpractice RVU: 0.41
- Conversion factor: 33.4009
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## NCCI edits

- Never-billable pair count: 138
- Modifier-allowed pair count: 177
- MUE units per patient per date of service: not published
- Complete list: https://localishealth.com/cpt/45378/ncci-edits.txt

## Source and citation

- Source: Physician relative value file (Q4 2026)
- CMS file: https://www.cms.gov/files/zip/rvu26d.zip
- Parsed file: PPRRVU2026_Oct_nonQPP.csv, row 5,513
- Canonical page: https://localishealth.com/cpt/45378
- Release-specific citation URL: https://localishealth.com/cpt/45378/2026/D
- Last significant update: 2026-08-26T06:15:42+00:00