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Medicare Physician Fee Schedule Effective Locality 07202-01 CMS RVU26D Updated

CPT 45385 Medicare rate in New Orleans, LA

Colonoscopy with polyp removal in ZIPs including 70112, 70130, and 70115

The Medicare allowed amount is $482.62 in the Office (non-facility) setting and $222.38 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

45385 Q4 2026
Locality-adjusted allowed amount
$482.62
in a doctor’s own office or clinic

New Orleans, LA flag New Orleans, LA (Locality 07202-01)

3.5% below the national baseline ($500.01)

CMS RVU26DOctober 1 – December 31, 2026revision 2

( Work4.46 × 1.000 + Practice exp.10.00 × 0.941 + Malpractice0.51 × 1.136 ) × Conv. factor$33.4009 = $482.62

row 5,520

F Work RVU

4.46

G Non‑facility PE RVU

10.00

K MP RVU

0.51

Z Conversion factor

33.4009

row 56

E Work GPCI

1.000

F PE GPCI

0.941

G MP GPCI

1.136

The Medicare allowed amount is $482.62 in the Office (non-facility) setting and $222.38 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

Assumes a participating provider, no modifiers, the whole service, before sequestration.

Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method

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What Medicare locality is New Orleans, LA in? Copy link

New Orleans, LA is in CMS payment locality New Orleans (07202-01). The same amount applies everywhere in it.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (110)

The CMS ZIP-to-locality crosswalk maps 110 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.

70001 70002 70003 70004 70005 70006 70009 70010 70011 70032 70033 70036 70037 70038 70040 70041 70042 70043 70044 70046 70050 70053 70054 70055 70056 70058 70059 70060 70062 70063 70064 70065 70067 70072 70073 70075 70081 70082 70083 70085 70091 70092 70093 70094 70096 70097 70112 70113 70114 70115 70116 70117 70118 70119 70121 70122 70123 70124 70125 70126 70127 70128 70129 70130 70131 70139 70140 70141 70142 70143 70145 70146 70148 70149 70150 70151 70152 70153 70154 70156 70157 70158 70159 70160 70161 70162 70163 70164 70165 70166 70167 70170 70172 70174 70175 70176 70177 70178 70179 70181

10 more ZIP codes map to this locality. The New Orleans, LA locality page lists the full set.

Which ZIP codes does the New Orleans, LA rate for 45385 cover?

The CMS ZIP-to-locality crosswalk maps 110 ZIP codes to this payment locality, and 45385 has the same amount in every one of them. Examples include 70001, 70002, 70003, 70004, 70005, 70006.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

New Orleans, LA (this locality)
$482.62
National PFS baseline (GPCI 1.000)
$500.01

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put New Orleans, LA 3.5% below the national baseline.

New Orleans, LA ranks #80 of 109 Medicare payment localities for 45385, where #1 has the highest allowed amount. Within Louisiana it's #1 of 2: $21.74 (4.7%) higher than Rest of Louisiana ($460.88).

Work GPCI
1.000
+$0.00 vs. national
Practice expense GPCI
0.941
-$19.71 vs. national
Malpractice GPCI
1.136
+$2.32 vs. national
2026 conversion factor
$33.4009

Each figure is that GPCI's share of the -$17.39 gap from the national baseline: its RVUs for 45385 × (GPCI − 1.000) × the conversion factor. Practice expense accounts for the most, -$19.71.

CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows

Why is the 45385 rate in New Orleans, LA 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 0.941, malpractice 1.136—scale each RVU component before the conversion factor is applied, which is why the New Orleans, LA amount is lower than the $500.01 baseline.

45385 in New Orleans, LA since Q4 2025 Copy link

Office (non-facility) · Participating · Whole service

The allowed amount went from $420.70 in Q4 2025 to $482.62 in Q4 2026, +$61.92 (+14.7%). The national baseline moved +14.8% over the same period.

What changed 45385's allowed amount in New Orleans, LA between Q4 2025 and Q4 2026
Conversion factor National: the dollar multiplier CMS sets each year. +$13.71
45385's RVUs National: CMS revalued the code itself. +$46.55
New Orleans, LA's GPCIs Local: this payment locality's cost indices. +$1.66
Total change +$61.92

A derived breakdown of the two releases' formula inputs, applied in order: the conversion factor on Q4 2025's RVUs and GPCIs, then 45385's new RVUs, then this locality's new GPCIs. A different order moves a few cents between rows; the total is exact.

Formula and inputs Copy link

For the office (non-facility) amount, each of 45385's RVU components is multiplied by its New Orleans, LA GPCI; the products are summed and multiplied by the conversion factor.

Code
45385
DOS
Not selected; uses this release’s rates
Locality
NEW ORLEANS (LA)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of New Orleans, LA allowed amount for 45385
Component RVU × GPCI = Adjusted
Work 4.46 × 1.000 4.4600
Practice expense · Office (non-facility) 10.00 × 0.941 9.4100
Malpractice 0.51 × 1.136 0.5794
Sum of adjusted RVUs 14.4494
× 33.4009 conversion factor = formula amount $482.62

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $482.62

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • 45385’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 5,520 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    45385
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    4.46
    G Non-facility PE RVU
    10.00
    K MP RVU
    0.51
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 5,518–5,522 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 07202-01’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 56 in rvu26d-updated-08-26-2026.zip

    A MAC
    07202
    C Locality number
    01
    E Work GPCI
    1.000
    F PE GPCI
    0.941
    G MP GPCI
    1.136
    In the CMS file

    Loading rows 54–58 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

CMS RVU26DOctober 1 – December 31, 2026revision 2

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 45385 in New Orleans, LA is $222.38, versus $482.62 in the Office (non-facility) setting. Only the practice-expense RVU changes with the setting: the facility bills its own fee for overhead, so the professional amount is lower. See which setting applies to your place of service.

What is the Facility amount for 45385 in New Orleans, LA?

$222.38 in a facility, versus $482.62 in the Office (non-facility) setting—a $260.24 difference. Only the practice-expense RVU changes with the setting: in the Office (non-facility) setting the practice carries the overhead, so the professional amount is higher; in a hospital or ASC the facility bills its own fee.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in New Orleans, LA. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 45385 in New Orleans, LA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $482.62
Non-participating allowed amount 95% of the participating amount. $458.49
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $527.26
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $386.10
Patient coinsurance The remaining 20%. $96.52
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $7.72
Net Medicare payment Medicare's share after the sequestration reduction. $378.38
What is the non-participating amount and limiting charge for 45385 in New Orleans, LA?

A non-participating provider is paid $458.49—95% of the $482.62 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $527.26, which is 115% of the non-participating amount.

How much of the New Orleans, LA 45385 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($386.10) once the annual Part B deductible is met, and the beneficiary owes 20% ($96.52). Sequestration reduces Medicare's share by about 2% ($7.72), leaving $378.38. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in New Orleans, LA Copy link

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$482.62 in the office (non-facility) setting—not the $500.01 national baseline.

Opens the calculator set to New Orleans, LA and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

45385 in nearby payment localities Copy link

Payment localities in the same region as New Orleans, LA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 45385. Neighboring localities often differ.

Percentages are against New Orleans, LA. Every payment locality nationwide is on the CPT 45385 rate map.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 07202-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 5,520)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 56)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices 45385 in New Orleans, LA against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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