CPT code 45308: Lesion removal, rigid scope, cautery technique2026 Medicare rate & RVUs
Reports removal of a distal rectal or rectosigmoid lesion during rigid proctosigmoidoscopy using hot biopsy forceps or bipolar cautery.
Medicare pays $227.13 for 45308 nationally in the office and $81.50 in a hospital or facility. Local office rates run $197.06–$302.84.
Medicare rate · 45308
Lesion removal, rigid scope, cautery technique
- Work RVUs
- 1.27
- Total RVUs
- 6.80
- Global days
- 000
National rate · 2026
$227.13
Office setting, before claim adjustments.
See every locality for 45308 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 45308 covers
A rigid proctosigmoidoscope is used to inspect the rectum and distal sigmoid and remove a tumor, polyp, or other lesion with hot biopsy forceps or bipolar cautery. Gastroenterologists and colorectal surgeons may perform the procedure in an office, endoscopy suite, or operating room. The operative note should identify the rigid scope, the lesion treated, and the removal technique; a diagnostic examination or tissue sampling alone does not establish this service.
Select this code for cautery removal, rather than snare removal or biopsy alone. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this anatomy and service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 45308 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$197.06 to $302.84
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $200.43 | $73.00 |
| Alaska | $254.33 | $99.24 |
| Arizona | $220.08 | $78.97 |
| Arkansas | $197.06 | $71.97 |
| Atlanta, GA | $232.37 | $84.41 |
| Austin, TX | $235.91 | $81.84 |
| Bakersfield, CA | $239.97 | $80.36 |
| Baltimore area, MD | $243.21 | $86.95 |
| Beaumont, TX | $210.72 | $78.20 |
| Brazoria, TX | $223.34 | $79.02 |
| Chicago, IL | $243.43 | $97.07 |
| Chico, CA | $239.03 | $79.42 |
| Colorado | $236.15 | $81.20 |
| Connecticut | $243.75 | $86.91 |
| Dallas, TX | $225.16 | $80.11 |
| Delaware | $224.08 | $80.20 |
| Detroit, MI | $229.09 | $88.56 |
| East St. Louis, IL | $225.14 | $91.16 |
| El Centro, CA | $239.09 | $79.48 |
| Fort Lauderdale, FL | $238.82 | $91.30 |
| Fort Worth, TX | $223.58 | $79.99 |
| Fresno, CA | $239.03 | $79.42 |
| Galveston, TX | $224.24 | $79.64 |
| Hanford, CA | $239.03 | $79.42 |
| Hawaii, Guam, HI | $245.91 | $80.33 |
| Houston, TX | $230.65 | $86.04 |
| Idaho | $207.12 | $73.15 |
| Indiana | $208.49 | $73.49 |
| Iowa | $205.37 | $72.12 |
| Kansas | $204.72 | $73.07 |
| Kentucky | $206.93 | $77.46 |
| King County, WA | $266.38 | $87.70 |
| Los Angeles, CA | $256.60 | $84.32 |
| Madera, CA | $239.03 | $79.42 |
| Manhattan, NY | $264.72 | $95.50 |
| Marin County, CA | $295.77 | $90.43 |
| Merced, CA | $239.03 | $79.42 |
| Metropolitan Boston, MA | $261.14 | $87.26 |
| Metropolitan Kansas City, MO | $216.30 | $79.56 |
| Metropolitan Philadelphia, PA | $237.24 | $85.64 |
| Metropolitan St. Louis, MO | $218.84 | $80.21 |
| Miami, FL | $252.09 | $100.50 |
| Minnesota | $223.91 | $74.06 |
| Mississippi | $200.03 | $74.64 |
| Modesto, CA | $239.03 | $79.42 |
| Montana | $227.10 | $81.47 |
| Napa, CA | $279.07 | $87.13 |
| Nebraska | $206.53 | $72.12 |
| Nevada | $225.35 | $79.57 |
| New Hampshire | $232.76 | $81.16 |
| New Mexico | $215.12 | $81.57 |
| New Orleans, LA | $218.51 | $81.47 |
| North Carolina | $211.31 | $75.44 |
| North Dakota | $220.18 | $74.55 |
| Northern New Jersey | $258.28 | $89.35 |
| NYC suburbs and Long Island, NY | $272.56 | $99.41 |
| Ohio | $212.17 | $79.21 |
| Oklahoma | $206.01 | $75.96 |
| Oxnard, CA | $255.40 | $83.26 |
| Portland, OR | $244.02 | $82.22 |
| Poughkeepsie and northern NYC suburbs, NY | $247.93 | $88.46 |
| Puerto Rico | $228.85 | $81.62 |
| Queens, NY | $266.50 | $94.36 |
| Redding, CA | $239.03 | $79.42 |
| Rest of California | $239.03 | $79.42 |
| Rest of Florida | $225.39 | $86.17 |
| Rest of Georgia | $210.68 | $80.78 |
| Rest of Illinois | $218.66 | $85.70 |
| Rest of Louisiana | $206.74 | $77.86 |
| Rest of Maine | $208.87 | $74.89 |
| Rest of Maryland | $228.67 | $81.29 |
| Rest of Massachusetts | $234.60 | $81.26 |
| Rest of Michigan | $213.58 | $80.62 |
| Rest of Missouri | $202.95 | $77.41 |
| Rest of New Jersey | $245.87 | $86.85 |
| Rest of New York | $215.00 | $76.66 |
| Rest of Oregon | $222.96 | $77.92 |
| Rest of Pennsylvania | $212.30 | $78.61 |
| Rest of Texas | $217.17 | $78.97 |
| Rest of Washington | $234.05 | $80.71 |
| Rhode Island | $232.38 | $81.95 |
| Riverside, CA | $242.78 | $83.17 |
| Sacramento, CA | $251.43 | $82.07 |
| Salinas, CA | $250.53 | $81.74 |
| San Benito County, CA | $302.84 | $92.85 |
| San Diego, CA | $256.96 | $82.78 |
| San Francisco, CA | $295.37 | $90.04 |
| San Luis Obispo, CA | $246.47 | $80.60 |
| Santa Clara County, CA | $301.22 | $91.22 |
| Santa Cruz, CA | $259.79 | $82.85 |
| Santa Maria, CA | $251.61 | $81.81 |
| Santa Rosa, CA | $262.42 | $83.59 |
| South Carolina | $212.22 | $77.66 |
| South Dakota | $219.36 | $73.74 |
| Southern Maine, ME | $221.26 | $76.94 |
| Stockton, CA | $239.03 | $79.42 |
| Suburban Chicago, IL | $241.12 | $91.56 |
| Tennessee | $205.97 | $73.59 |
| Utah | $215.55 | $78.66 |
| Vallejo, CA | $278.49 | $86.56 |
| Vermont | $219.62 | $75.45 |
| Virgin Islands, VI | $228.85 | $81.62 |
| Virginia | $220.75 | $77.60 |
| Visalia, CA | $239.03 | $79.42 |
| Washington, DC area | $261.53 | $89.99 |
| West Virginia | $209.50 | $82.95 |
| Wisconsin | $211.77 | $72.26 |
| Wyoming | $224.09 | $78.46 |
| Yuba City, CA | $239.03 | $79.42 |
45308 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$197.06
$270.94
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $254.33 | 1 |
| AL | $200.43 | 1 |
| AR | $197.06 | 1 |
| AZ | $220.08 | 1 |
| CA | $239.03–$302.84 | 29 |
| CO | $236.15 | 1 |
| CT | $243.75 | 1 |
| DC | $261.53 | 1 |
| DE | $224.08 | 1 |
| FL | $225.39–$252.09 | 3 |
| GA | $210.68–$232.37 | 2 |
| GU | $245.91 | 1 |
| HI | $245.91 | 1 |
| IA | $205.37 | 1 |
| ID | $207.12 | 1 |
| IL | $218.66–$243.43 | 4 |
| IN | $208.49 | 1 |
| KS | $204.72 | 1 |
| KY | $206.93 | 1 |
| LA | $206.74–$218.51 | 2 |
| MA | $234.60–$261.14 | 2 |
| MD | $228.67–$261.53 | 3 |
| ME | $208.87–$221.26 | 2 |
| MI | $213.58–$229.09 | 2 |
| MN | $223.91 | 1 |
| MO | $202.95–$218.84 | 3 |
| MS | $200.03 | 1 |
| MT | $227.10 | 1 |
| NC | $211.31 | 1 |
| ND | $220.18 | 1 |
| NE | $206.53 | 1 |
| NH | $232.76 | 1 |
| NJ | $245.87–$258.28 | 2 |
| NM | $215.12 | 1 |
| NV | $225.35 | 1 |
| NY | $215.00–$272.56 | 5 |
| OH | $212.17 | 1 |
| OK | $206.01 | 1 |
| OR | $222.96–$244.02 | 2 |
| PA | $212.30–$237.24 | 2 |
| PR | $228.85 | 1 |
| RI | $232.38 | 1 |
| SC | $212.22 | 1 |
| SD | $219.36 | 1 |
| TN | $205.97 | 1 |
| TX | $210.72–$235.91 | 8 |
| UT | $215.55 | 1 |
| VA | $220.75–$261.53 | 2 |
| VI | $228.85 | 1 |
| VT | $219.62 | 1 |
| WA | $234.05–$266.38 | 2 |
| WI | $211.77 | 1 |
| WV | $209.50 | 1 |
| WY | $224.09 | 1 |
How the 45308 rate is calculated
Each of 45308’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45308
RVUs × geographic indexes × conversion factor
Work1.27
1.27 RVUs× 1.000 GPCI
Practice expense5.18
5.18 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
6.8000
Conversion factor
$33.4009
Medicare rate
$227.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45308
The CMS indicators that decide how 45308 is paid alongside other services.
CMS payment indicators · 45308
Lesion removal, rigid scope, cautery technique
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45308 without 51 · national office
$227.13
Lesion removal, rigid scope, cautery technique
45308-51 · Second procedure: 50%
$113.57
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45308 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45309ProctosigmoidoscopySnare lesion removal
- Use 45308 when hot biopsy forceps or bipolar cautery removes the lesion. Use 45309 when a snare is used.
- 45305ProctosigmoidoscopyRigid scope with biopsy
- 45305 reports biopsy during rigid proctosigmoidoscopy; 45308 represents cautery removal of a lesion.
- 45333Flexible sigmoidoscopyHot biopsy forceps removal
- 45333 is the flexible-scope counterpart for lesion removal by hot biopsy forceps or bipolar cautery. This code is for rigid proctosigmoidoscopy.
- 45330Flexible sigmoidoscopyDiagnostic
- 45330 is diagnostic flexible sigmoidoscopy. Choose 45308 when a lesion is removed with the specified cautery technique during rigid proctosigmoidoscopy.
45308 billing questions
How does this differ from 45309?
This code represents lesion removal with hot biopsy forceps or bipolar cautery. Code 45309 is the related rigid-scope option when the lesion is removed by snare.
Can I report this for a biopsy?
No. Biopsy without the described cautery removal is represented by 45305 for rigid proctosigmoidoscopy.
Can diagnostic endoscopy be separately reported with this service?
When related endoscopies are performed together, CMS endoscopy-family pricing applies. The procedure documentation should support the therapeutic service and any separately reported endoscopy.
Should modifier 50 be appended for multiple lesions or sides?
No. Modifier 50 is inappropriate for this service and anatomy; the CMS bilateral adjustment does not apply.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.
What is included in the 0-day global period?
Same-day preoperative and postoperative care is included. The global period is 0 days.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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