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CPT code 45308: Lesion removal, rigid scope, cautery technique2026 Medicare rate & RVUs in Houston, TX

Reports removal of a distal rectal or rectosigmoid lesion during rigid proctosigmoidoscopy using hot biopsy forceps or bipolar cautery.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Houston, TX, Medicare pays $230.65 for 45308 in the office and $86.04 when it’s performed in a hospital or facility.

$230.65Office (non-facility)
$86.04Hospital or facility
+1.5%vs the national office rate ($227.13)

Check a contract rate as a % of Medicare · 45308 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 45308 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 45308 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Houston, TX compares for 45308

Across 109 of 109 payment localities, the office rate for 45308 runs from $197.06 in Arkansas to $302.84 in San Benito County, CA. Houston, TX pays $230.65. The RVUs are the same everywhere; the geographic indexes change the dollars.

45308 in Houston, TX vs other payment areas
  1. Houston, TX · this page$230.65
  2. Austin, TX · Texas$235.91+$5.26
  3. Beaumont, TX · Texas$210.72−$19.93
  4. Brazoria, TX · Texas$223.34−$7.31
  5. Dallas, TX · Texas$225.16−$5.49
  6. Fort Worth, TX · Texas$223.58−$7.07
  7. Galveston, TX · Texas$224.24−$6.41

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

45308 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$217.17$78.97
Los Angeles, CACalifornia$256.60$84.32
Washington, DC areaDistrict of Columbia$261.53$89.99
Miami, FLFlorida$252.09$100.50
Chicago, ILIllinois$243.43$97.07
Manhattan, NYNew York$264.72$95.50
AlaskaAlaska$254.33$99.24
AlabamaAlabama$200.43$73.00

45308 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
45308 office rate range by state
State / territoryOffice rate rangeLocalities
AK$254.331
AL$200.431
AR$197.061
AZ$220.081
CA$239.03–$302.8429
CO$236.151
CT$243.751
DC$261.531
DE$224.081
FL$225.39–$252.093
GA$210.68–$232.372
GU$245.911
HI$245.911
IA$205.371
ID$207.121
IL$218.66–$243.434
IN$208.491
KS$204.721
KY$206.931
LA$206.74–$218.512
MA$234.60–$261.142
MD$228.67–$261.533
ME$208.87–$221.262
MI$213.58–$229.092
MN$223.911
MO$202.95–$218.843
MS$200.031
MT$227.101
NC$211.311
ND$220.181
NE$206.531
NH$232.761
NJ$245.87–$258.282
NM$215.121
NV$225.351
NY$215.00–$272.565
OH$212.171
OK$206.011
OR$222.96–$244.022
PA$212.30–$237.242
PR$228.851
RI$232.381
SC$212.221
SD$219.361
TN$205.971
TX$210.72–$235.918
UT$215.551
VA$220.75–$261.532
VI$228.851
VT$219.621
WA$234.05–$266.382
WI$211.771
WV$209.501
WY$224.091

See 45308 in every payment locality

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

Office or facility?

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.

The exact Houston, TX inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,491

Code
45308
Physician work
1.27
Practice expense
5.18
Malpractice
0.35

GPCI2026.csv

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 45308 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.27× 1.0081.2802
Practice expense5.18× 0.9935.1437
Malpractice0.35× 1.3760.4816
Total RVUs6.9055
Conversion factor× 33.4009

Office rate, Houston, TX$230.65

Office: (1.27 × 1.008 + 5.18 × 0.993 + 0.35 × 1.376) × $33.4009 = $230.65

Facility: (1.27 × 1.008 + 0.82 × 0.993 + 0.35 × 1.376) × $33.4009 = $86.04

Open 45308 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 45308

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 45308
CodeHow it relatesOffice range, Houston, TX
Same family
45309Proctosigmoidoscopy, snare lesion removalRigid proctosigmoidoscopic lesion removal using snare technique.$237.92
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy rather than cautery removal.$200.13
Used instead
45333Flexible sigmoidoscopy, hot biopsy forceps removalFlexible sigmoidoscopy option for lesion removal using hot biopsy forceps or bipolar cautery.$369.07
45330Flexible sigmoidoscopy, diagnosticFlexible diagnostic sigmoidoscopy when no lesion-removal service is performed.$215.54

How 45308 has changed in Houston, TX

45308 · Office / nonfacility

$230.65

Effective 2026-10-01

The base rate is $29.44 higher than on 2025-10-01, moving from $201.21 to $230.65 (14.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $201.21changed to$230.65

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.30 changed to 1.27
    • Practice expense RVU 4.41 changed to 5.18
    • Malpractice RVU 0.34 changed to 0.35
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $210.07changed to$201.21

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.50 changed to 4.41

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $206.64changed to$210.07

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $215.36changed to$206.64

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.56 changed to 4.50
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $222.65changed to$215.36

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.66 changed to 4.56
    • Malpractice RVU 0.33 changed to 0.34
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $219.87changed to$222.65

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.54 changed to 4.66
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $192.36changed to$219.87

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.63 changed to 4.54
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $179.30changed to$192.36

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.31 changed to 3.63
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $167.48changed to$179.30

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.00 changed to 3.31
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $164.58changed to$167.48

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.94 changed to 3.00
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $221.58changed to$164.58

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.40 changed to 1.30
    • Practice expense RVU 4.43 changed to 2.94
    • Malpractice RVU 0.32 changed to 0.31
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $227.07changed to$221.58

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.55 changed to 4.43
    • Malpractice RVU 0.33 changed to 0.32

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $225.94changed to$227.07

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $222.19changed to$225.94

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.53 changed to 4.55
    • Malpractice RVU 0.25 changed to 0.33
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $223.27changed to$222.19

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.90 changed to 4.53
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $223.27

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$230.65$86.04RVU26D
2026-07-01$230.65$86.04RVU26C
2026-04-01$230.65$86.04RVU26B
2026-01-01$230.65$86.04RVU26A
2025-10-01$201.21$87.98RVU25D
2025-07-01$201.21$87.98RVU25C
2025-04-01$201.21$87.98RVU25B
2025-01-01$201.21$87.98RVU25A
2024-10-01$210.07$89.87RVU24D
2024-07-01$210.07$89.87RVU24C
2024-04-01$210.07$89.87RVU24B
2024-03-09$210.07$89.87RVU24AR
2024-01-01$206.64$88.41RVU24A
2023-10-01$215.36$88.66RVU23D
2023-07-01$215.36$88.66RVU23C
2023-04-01$215.36$88.66RVU23B
2023-01-01$215.36$88.66RVU23A
2022-10-01$222.65$87.69RVU22D
2022-07-01$222.65$87.69RVU22C
2022-04-01$222.65$87.69RVU22B
2022-01-01$222.65$87.69RVU22A
2021-10-01$219.87$87.38RVU21D
2021-07-01$219.87$87.38RVU21C
2021-04-01$219.87$87.38RVU21B
2021-01-01$219.87$87.38RVU21A
2020-10-01$192.36$88.92RVU20D
2020-07-01$192.36$88.92RVU20C
2020-04-01$192.36$88.92RVU20B
2020-01-01$192.36$88.92RVU20A
2019-10-01$179.30$88.12RVU19D
2019-07-01$179.30$88.12RVU19C
2019-04-01$179.30$88.12RVU19B
2019-01-01$179.30$88.12RVU19A
2018-10-01$167.48$88.06RVU18D
2018-07-01$167.48$88.06RVU18C
2018-04-01$167.48$88.06RVU18B
2018-01-01$167.48$88.06RVU18AR1
2017-10-01$164.58$88.17RVU17D
2017-07-01$164.58$88.17RVU17C
2017-04-01$164.58$88.17RVU17B
2017-01-01$164.58$88.17RVU17A
2016-10-01$221.58$93.00RVU16D
2016-07-01$221.58$93.00RVU16C
2016-04-01$221.58$93.00RVU16B
2016-01-01$221.58$93.00RVU16A
2015-10-01$227.07$93.68RVU15D
2015-07-01$227.07$93.68RVU15C
2015-04-01$225.94$93.21RVU15B
2015-01-01$225.94$93.21RVU15A
2014-10-01$222.19$90.55RVU14D
2014-07-01$222.19$90.55RVU14C
2014-04-01$222.19$90.55RVU14B
2014-01-01$222.19$90.55RVU14A
2013-10-01$223.27$89.29RVU13D
2013-07-01$223.27$89.29RVU13C
2013-04-01$223.27$89.29RVU13B
2013-01-01$223.27$89.29RVU13AR

Price 45308 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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
RVUs for 45308PPRRVU2026_Oct_nonQPP.csv, line 5,491 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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