CPT code 45309: Proctosigmoidoscopy, snare lesion removal2026 Medicare rate & RVUs in California
Reports rigid proctosigmoidoscopy in which a clinician removes a rectal or distal sigmoid lesion using a snare.
Medicare pays $246.08–$311.24 for 45309 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
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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What 45309 covers
A clinician uses a rigid proctosigmoidoscope to examine the rectum and distal sigmoid and remove a tumor, polyp, or other lesion with a snare. Gastroenterologists and colorectal or general surgeons may perform the procedure in an endoscopy unit, hospital, or office setting. The snare technique distinguishes this service from lesion removal by hot biopsy forceps or bipolar cautery and from flexible sigmoidoscopy.
Select the code when the procedure documentation supports rigid scope use and snare removal; record the lesion site, findings, and technique. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, Medicare endoscopy-family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery reporting 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 45309 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$246.08 to $311.24
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $247.08 | $84.91 |
| Chico, CA | $246.08 | $83.91 |
| El Centro, CA | $246.14 | $83.97 |
| Fresno, CA | $246.08 | $83.91 |
| Hanford, CA | $246.08 | $83.91 |
| Los Angeles, CA | $264.08 | $89.03 |
| Madera, CA | $246.08 | $83.91 |
| Marin County, CA | $303.97 | $95.34 |
| Merced, CA | $246.08 | $83.91 |
| Modesto, CA | $246.08 | $83.91 |
| Napa, CA | $286.92 | $91.90 |
| Oxnard, CA | $262.80 | $87.90 |
| Redding, CA | $246.08 | $83.91 |
| Rest of California | $246.08 | $83.91 |
| Riverside, CA | $250.05 | $87.87 |
| Sacramento, CA | $258.75 | $86.66 |
| Salinas, CA | $257.81 | $86.32 |
| San Benito County, CA | $311.24 | $97.87 |
| San Diego, CA | $264.35 | $87.39 |
| San Francisco, CA | $303.55 | $94.92 |
| San Luis Obispo, CA | $253.65 | $85.12 |
| Santa Clara County, CA | $309.52 | $96.16 |
| Santa Cruz, CA | $267.21 | $87.43 |
| Santa Maria, CA | $258.91 | $86.38 |
| Santa Rosa, CA | $269.91 | $88.21 |
| Stockton, CA | $246.08 | $83.91 |
| Vallejo, CA | $286.31 | $91.29 |
| Visalia, CA | $246.08 | $83.91 |
| Yuba City, CA | $246.08 | $83.91 |
How the 45309 rate is calculated
Each of 45309’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 · 45309
RVUs × geographic indexes × conversion factor
Work1.37
1.37 RVUs× 1.000 GPCI
Practice expense5.27
5.27 RVUs× 1.000 GPCI
Malpractice0.37
0.37 RVUs× 1.000 GPCI
Adjusted RVUs
7.0100
Conversion factor
$33.4009
Medicare rate
$234.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45309
The CMS indicators that decide how 45309 is paid alongside other services.
CMS payment indicators · 45309
Proctosigmoidoscopy, snare lesion removal
| 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
45309 without 51 · national office
$234.14
Proctosigmoidoscopy, snare lesion removal
45309-51 · Second procedure: 50%
$117.07
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%).
45309 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45308Lesion removalRigid scope, cautery technique
- Both involve rigid proctosigmoidoscopy and lesion removal. Choose this code for snare technique; 45308 describes removal with hot biopsy forceps or bipolar cautery.
- 45315ProctosigmoidoscopySnare removal of lesion
- This code describes snare removal. Code 45315 describes removal of multiple lesions by hot biopsy forceps during rigid proctosigmoidoscopy.
- 45338Flexible sigmoidoscopySnare lesion removal
- Both describe snare removal, but 45309 is for rigid proctosigmoidoscopy and 45338 is for flexible sigmoidoscopy.
- 45305ProctosigmoidoscopyRigid scope with biopsy
- Code 45305 is for biopsy during rigid proctosigmoidoscopy. Use this code when the documented service is snare removal of a lesion.
45309 billing questions
How does this differ from code 45308?
This code identifies snare removal during rigid proctosigmoidoscopy. Code 45308 is for lesion removal using hot biopsy forceps or bipolar cautery.
Can this code describe flexible sigmoidoscopy with snare removal?
No. This code is for rigid proctosigmoidoscopy; flexible sigmoidoscopy with snare removal is reported with code 45338.
What documentation supports the code?
Document that a rigid proctosigmoidoscope was used and that a lesion was removed with a snare. Include the lesion location and procedural findings.
Can modifier 50 be used?
No. Modifier 50 is inappropriate for this rectal and distal sigmoid service.
How are related endoscopies priced when performed together?
Medicare endoscopy-family pricing applies when related endoscopies are performed together. The payment calculation follows that family pricing rather than treating each as an unrelated procedure.
Is an assistant or co-surgeon payable for this procedure?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery reporting are not permitted.
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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