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Medicare Physician Fee Schedule · Q3 2026 release

CPT 45384 in Richmond, VA 11302-00

45384 2026 C · Richmond, VA flag11302-00 A Active
Allowed amount
$526.86
in a doctor’s own office or clinic

97.7% of the $539.42 national baseline

Medicare payment
$421.49
Patient / secondary
$105.37
Expected total to provider
$526.86

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 45384 in Richmond, VA? Copy link

The Medicare allowed amount is $526.86 in the office (non-facility) setting and $196.56 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 2.3% below the national baseline, and the facility amount is 3.4% below the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Richmond, VA in? Copy link

CMS prices all of Virginia as one Medicare payment locality, so this amount applies statewide, including Virginia Beach, Norfolk, Chesapeake and Roanoke — not only in Richmond, VA.

Why Richmond, VA differs from the national amount Copy link

Richmond, VA (this locality)
$526.86
National PFS baseline (GPCI 1.000)
$539.42

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Richmond, VA at 2.3% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.983
Malpractice GPCI
0.706
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 45384 in Richmond, VA: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Richmond, VA allowed amount for 45384
Component RVU × GPCI = Adjusted RVU
Work 3.97 1.000 3.9700
Practice expense 11.57 0.983 11.3733
Malpractice 0.61 0.706 0.4307
Sum of adjusted RVUs 15.7740
× $33.4009 2026 conversion factor $526.86

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Richmond, VA allows $196.56 for 45384, versus $526.86 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Richmond, VA. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 45384 in Richmond, VA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $526.86
Non-participating allowed amount 95% of the participating amount. $500.52
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $575.60
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $421.49
Beneficiary coinsurance The remaining 20%. $105.37
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $8.43
Medicare pays after sequestration Program payment net of the sequestration reduction. $413.06

Contracted rate: % of Medicare in Richmond, VA Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $526.86 in the office (non-facility) setting — not the $539.42 national baseline.

Opens the calculator already set to Richmond, VA and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Richmond, VA rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 1,145 ZIP codes to this payment locality. 45384 prices identically in every one of them. 1 of them span more than one locality and need ZIP+4 for an exact match.

00303 00304 00323 00353 20101 20102 20103 20104 20105 20106 20107 20108 20109 20110 20111 20112 20113 20115 20116 20117 20118 20119 20128 20129 20130 20131 20132 20134 20135 20136 20137 20138 20139 20140 20141 20142 20143 20144 20146 20147 20148 20149 20152 20155 20156 20158 20159 20160 20163 20164 20165 20166 20167 20168 20169 20175 20176 20177 20178 20180 20181 20182 20184 20185 20186 20187 20188 20189 20197 20198 20199 20598 22002 22025 22026 22093 22125 22134 22135 22172 22191 22192 22193 22194 22195 22401 22402 22403 22404 22405 22406 22407 22408 22412 22427 22428 22430 22432 22433 22435

1,045 more ZIP codes map to this locality. The Richmond, VA locality page lists the full set.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

45384 in nearby payment localities Copy link

Payment localities in the same region as Richmond, VA, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 45384. Proximity doesn't imply similar pricing — neighbouring localities often differ.

45384 allowed amount in payment localities near Richmond, VA
Metro Allowed amount vs. Richmond, VA
Washington, DC $617.68 +17.2%
Baltimore, MD $574.59 +9.1%
Charlotte, NC $506.18 -3.9%
Charleston, SC $507.00 -3.8%
Philadelphia, PA $561.59 +6.6%
Pittsburgh, PA $506.62 -3.8%

Every payment locality nationwide is on the CPT 45384 rate map.

Other codes priced in Richmond, VA Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Richmond, VA
Code Service Richmond, VA vs. national
43239 Upper Gastrointestinal Endoscopy With Tissue Sampling $410.55 -2.0%
45385 Colonoscopy With Polyp Removal $489.33 -2.1%
45380 Colonoscopy With Tissue Sampling $469.90 -2.1%
45378 Diagnostic Colonoscopy $369.68 -2.2%
43235 Screening and endoscopy $316.11 -2.0%
45381 Screening and endoscopy $480.07 -2.1%
G0105 Screening and endoscopy $369.68 -2.2%
G0121 Screening and endoscopy $369.92 -2.2%
99213 Routine Follow-Up Office Visit $93.48 -1.8%
99214 Long Follow-Up Office Visit $133.10 -1.9%
66984 Cataract Surgery $453.81 -1.9%
92014 Full Eye Exam, Returning Patient $125.53 -1.4%

Common questions Copy link

Which ZIP codes does the Richmond, VA rate for 45384 cover?
The CMS ZIP-to-locality crosswalk maps 1,145 ZIP codes to this payment locality, and every one of them prices 45384 identically. Examples include 00303, 00304, 00323, 00353, 20101, 20102. 1 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 45384 rate in Richmond, VA different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.000, practice expense 0.983, malpractice 0.706 — scale each RVU component before the conversion factor is applied, which is why Richmond, VA allows less than the $539.42 baseline.
Does this 45384 rate apply everywhere in Virginia?
Yes. CMS prices Virginia as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Richmond, VA. That includes Virginia Beach, Norfolk, Chesapeake and Roanoke. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.
What is the facility rate for 45384 in Richmond, VA?
$196.56 in a facility, versus $526.86 in the office (non-facility) setting — a $330.30 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 45384 in Richmond, VA?
A non-participating provider is paid $500.52 — 95% of the $526.86 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $575.60, which is 115% of the non-participating amount.
How much of the Richmond, VA 45384 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($421.49) once the annual Part B deductible is met, and the beneficiary owes 20% ($105.37). Sequestration reduces Medicare's share by about 2% ($8.43), leaving $413.06. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 11302-00's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 5,459)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 106)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 45384 in Richmond, VA against the release that governed that date. Past releases need a free account; today's rate does not.

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