HCPCS 45378

Procedure (ClaimLight category; the code descriptor is not shown)

Procedures Work RVU per service 3.26 (2021 fee schedule)

10,135
97th percentile among 6,253 codes billed · 2021
$58M
96th percentile among 6,253 codes billed · 2021
324K
91st percentile among 6,253 codes billed · 2021
22
46th percentile among 6,253 codes billed · 2021
86
52nd percentile among 6,253 codes billed · 2021
+7.7%
Medicare payment on the code vs 2020; billers +3.5% · 2021

Trend

Medicare payment on the code

$0$25M$50M2020: $54M paid20202021: $58M paid20212022: $52M paid20222023: $50M paid20232024: $48M paid2024$48M$0$25M$50M2020: $54M paid20202021: $58M paid20212022: $52M paid20222023: $50M paid20232024: $48M paid2024$48M$0$25M$50M2020: $54M paid20202021: $58M paid20212022: $52M paid20222023: $50M paid20232024: $48M paid2024$48M$0$25M$50M2020: $54M paid20202021: $58M paid20212022: $52M paid20222023: $50M paid20232024: $48M paid2024$48M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

05,00010K2020: 9,788 providers20202021: 10K providers20212022: 9,419 providers20222023: 8,675 providers20232024: 8,154 providers20248,15405,00010K2020: 9,788 providers20202021: 10K providers20212022: 9,419 providers20222023: 8,675 providers20232024: 8,154 providers20248,15405,00010K2020: 9,788 providers20202021: 10K providers20212022: 9,419 providers20222023: 8,675 providers20232024: 8,154 providers20248,15405,00010K2020: 9,788 providers20202021: 10K providers20212022: 9,419 providers20222023: 8,675 providers20232024: 8,154 providers20248,154

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
20248,154$47,700,328-4%237,38520763.26
20238,675$49,874,389-4%258,79720793.26
20229,419$51,965,549-10%293,48721833.26
202110,135$57,844,508+8%324,36522863.26
20209,788$53,702,661first year in data307,81022833.26

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
New York778$6,853,50430,14824107
California869$6,218,47231,3122598
Florida758$4,713,26826,3872399
Texas639$3,240,64619,2952175
New Jersey410$2,848,46314,00922102
Pennsylvania485$2,383,77613,3142073
Illinois415$1,933,87311,7882073
Maryland248$1,927,46610,41627121
Ohio415$1,865,36211,4161972
North Carolina309$1,752,9469,8812377
Georgia292$1,696,9609,7312376
Tennessee258$1,453,8358,8592298
South Carolina201$1,411,5938,35427119
Michigan283$1,338,9368,0102173
Arizona208$1,328,6397,1242486

Not listed: 2 billers with an armed-forces or unknown state code (ZZ); they are in the national totals.

Not listed: 3 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ882$7,780,89633,88024
Los Angeles-Long Beach-Anaheim, CA288$2,160,90210,78924
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD261$1,300,7436,93720
Chicago-Naperville-Elgin, IL-IN290$1,199,1087,38719
Washington-Arlington-Alexandria, DC-VA-MD-WV184$1,130,7035,88821
Baltimore-Columbia-Towson, MD122$944,3295,22628
Phoenix-Mesa-Chandler, AZ143$905,4294,74024
Miami-Fort Lauderdale-West Palm Beach, FL160$883,1374,84121
Atlanta-Sandy Springs-Roswell, GA147$751,7634,17621
Boston-Cambridge-Newton, MA-NH172$713,6234,50420
Dallas-Fort Worth-Arlington, TX144$712,4123,88920
Detroit-Warren-Dearborn, MI142$697,1824,13222
San Francisco-Oakland-Fremont, CA106$661,5363,17824
Houston-Pasadena-The Woodlands, TX121$599,2863,45520
Las Vegas-Henderson-North Las Vegas, NV61$549,9652,73827

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 98 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.

Specialties billing 45378 nationally

Gastroenterology accounts for 49% of payment for 45378 nationally in 2021, across 6 specialties on claims.

observed calculated calculated calculated calculated calculated
Gastroenterology6,88868%$28,153,50849%191,41628
Ambulatory Surgical Center1,44814%$23,493,36641%89,56062
General Surgery1,02910%$3,237,8825.6%23,89423
Internal Medicine4114.1%$1,676,4002.9%11,11727
Colorectal Surgery (Proctology)2812.8%$1,013,5301.8%6,65324
Family Practice270.27%$62,5620.11%45117

Not listed: 17 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2021.

Top billers of 45378 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations