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CPT code 45309: Proctosigmoidoscopy, snare lesion removal2026 Medicare rate & RVUs in Puerto Rico

Reports rigid proctosigmoidoscopy in which a clinician removes a rectal or distal sigmoid lesion using a snare.

CMS RVU26DEffective Oct 1, 2026One payment locality20 Medicare services in 2024

In Puerto Rico, Medicare pays $235.89 for 45309 in the office and $86.30 when it’s performed in a hospital or facility.

$235.89Office (non-facility)
$86.30Hospital or facility
+0.7%vs the national office rate ($234.14)

Check a contract rate as a % of Medicare · 45309 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 45309 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 45309 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 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.

How Puerto Rico compares for 45309

Across 109 of 109 payment localities, the office rate for 45309 runs from $203.33 in Arkansas to $311.24 in San Benito County, CA. Puerto Rico pays $235.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

45309 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$235.89
  2. Los Angeles, CA · California$264.08+$28.19
  3. Washington, DC area · District of Columbia$269.34+$33.45
  4. Miami, FL · Florida$260.25+$24.36
  5. Chicago, IL · Illinois$251.34+$15.45
  6. Manhattan, NY · New York$272.83+$36.94
  7. Alaska · Alaska$262.91+$27.02

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

Every other payment area

45309 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$206.77$77.30
ArkansasArkansas$203.33$76.22
ArizonaArizona$226.90$83.52
Bakersfield, CACalifornia$247.08$84.91
Chico, CACalifornia$246.08$83.91
El Centro, CACalifornia$246.14$83.97
Fresno, CACalifornia$246.08$83.91
Hanford, CACalifornia$246.08$83.91

45309 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.

$203.33

$278.66

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
45309 office rate range by state
State / territoryOffice rate rangeLocalities
AK$262.911
AL$206.771
AR$203.331
AZ$226.901
CA$246.08–$311.2429
CO$243.251
CT$251.201
DC$269.341
DE$231.011
FL$232.61–$260.253
GA$217.50–$239.582
GU$253.051
HI$253.051
IA$211.731
ID$213.551
IL$225.78–$251.344
IN$214.941
KS$211.111
KY$213.551
LA$213.38–$225.442
MA$241.69–$268.812
MD$235.70–$269.343
ME$215.39–$228.002
MI$220.42–$236.462
MN$230.541
MO$209.53–$225.723
MS$206.451
MT$234.121
NC$217.891
ND$226.801
NE$212.901
NH$239.811
NJ$253.36–$266.032
NM$222.011
NV$232.251
NY$221.67–$280.935
OH$218.931
OK$212.551
OR$229.77–$251.252
PA$219.03–$244.572
PR$235.891
RI$239.481
SC$218.911
SD$225.931
TN$212.401
TX$217.42–$243.038
UT$222.321
VA$227.51–$269.342
VI$235.891
VT$226.281
WA$241.11–$274.122
WI$218.201
WV$216.411
WY$230.931

See 45309 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,492

Code
45309
Physician work
1.37
Practice expense
5.27
Malpractice
0.37

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 45309 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.37× 1.0001.3700
Practice expense5.27× 1.0115.3280
Malpractice0.37× 0.9850.3644
Total RVUs7.0624
Conversion factor× 33.4009

Office rate, Puerto Rico$235.89

Office: (1.37 × 1 + 5.27 × 1.011 + 0.37 × 0.985) × $33.4009 = $235.89

Facility: (1.37 × 1 + 0.84 × 1.011 + 0.37 × 0.985) × $33.4009 = $86.30

Open 45309 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 45309

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

Codes related to 45309
CodeHow it relatesOffice range, Puerto Rico
Used instead
45308Lesion removal, rigid scope, cautery techniqueRigid proctosigmoidoscopy lesion removal using hot biopsy forceps or bipolar cautery.$228.85
45338Flexible sigmoidoscopy, snare lesion removalFlexible sigmoidoscopy with snare removal rather than rigid proctosigmoidoscopy.$337.74
45300Proctosigmoidoscopy, rigid, diagnosticRigid diagnostic proctosigmoidoscopy without the snare-removal service.$149.87
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy rather than snare removal.$200.00
Same family
45315Proctosigmoidoscopy, snare removal of lesionRigid proctosigmoidoscopy with removal of multiple lesions by hot biopsy forceps.$252.95

How 45309 has changed in Puerto Rico

45309 · Office / nonfacility

$235.89

Effective 2026-10-01

The base rate is $32.92 higher than on 2025-10-01, moving from $202.97 to $235.89 (16.2%).

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

    $202.97changed to$235.89

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.40 changed to 1.37
    • Practice expense RVU 4.49 changed to 5.27
    • Malpractice RVU 0.36 changed to 0.37
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $211.56changed to$202.97

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.57 changed to 4.49

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $208.11changed to$211.56

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $217.27changed to$208.11

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.63 changed to 4.57
    • Malpractice RVU 0.35 changed to 0.36
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $216.20changed to$217.27

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $225.40changed to$216.20

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.74 changed to 4.63
    • Malpractice RVU 0.34 changed to 0.35
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $222.69changed to$225.40

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.61 changed to 4.74

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $196.88changed to$222.69

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.69 changed to 4.61
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $184.89changed to$196.88

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.37 changed to 3.69
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $173.09changed to$184.89

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.06 changed to 3.37
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $150.24changed to$173.09

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.00 changed to 3.06
    • Malpractice RVU 0.34 changed to 0.33
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $173.24changed to$150.24

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.50 changed to 1.40
    • Practice expense RVU 4.59 changed to 3.00
    • Malpractice RVU 0.35 changed to 0.34
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $172.90changed to$173.24

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.61 changed to 4.59
    • Malpractice RVU 0.21 changed to 0.35

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $172.04changed to$172.90

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $169.79changed to$172.04

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.58 changed to 4.61
    • Malpractice RVU 0.26 changed to 0.21
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $167.51changed to$169.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.95 changed to 4.58
    • Malpractice RVU 0.27 changed to 0.26
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $167.51

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$235.89$86.30RVU26D
2026-07-01$235.89$86.30RVU26C
2026-04-01$235.89$86.30RVU26B
2026-01-01$235.89$86.30RVU26A
2025-10-01$202.97$87.99RVU25D
2025-07-01$202.97$87.99RVU25C
2025-04-01$202.97$87.99RVU25B
2025-01-01$202.97$87.99RVU25A
2024-10-01$211.56$89.54RVU24D
2024-07-01$211.56$89.54RVU24C
2024-04-01$211.56$89.54RVU24B
2024-03-09$211.56$89.54RVU24AR
2024-01-01$208.11$88.08RVU24A
2023-10-01$217.27$90.54RVU23D
2023-07-01$216.20$90.48RVU23C
2023-04-01$216.20$90.48RVU23B
2023-01-01$216.20$90.48RVU23A
2022-10-01$225.40$91.44RVU22D
2022-07-01$225.40$91.44RVU22C
2022-04-01$225.40$91.44RVU22B
2022-01-01$225.40$91.44RVU22A
2021-10-01$222.69$91.85RVU21D
2021-07-01$222.69$91.85RVU21C
2021-04-01$222.69$91.85RVU21B
2021-01-01$222.69$91.85RVU21A
2020-10-01$196.88$93.93RVU20D
2020-07-01$196.88$93.93RVU20C
2020-04-01$196.88$93.93RVU20B
2020-01-01$196.88$93.93RVU20A
2019-10-01$184.89$93.43RVU19D
2019-07-01$184.89$93.43RVU19C
2019-04-01$184.89$93.43RVU19B
2019-01-01$184.89$93.43RVU19A
2018-10-01$173.09$93.34RVU18D
2018-07-01$173.09$93.34RVU18C
2018-04-01$173.09$93.34RVU18B
2018-01-01$173.09$93.34RVU18AR1
2017-10-01$150.24$84.50RVU17D
2017-07-01$150.24$84.50RVU17C
2017-04-01$150.24$84.50RVU17B
2017-01-01$150.24$84.50RVU17A
2016-10-01$173.24$80.10RVU16D
2016-07-01$173.24$80.10RVU16C
2016-04-01$173.24$80.10RVU16B
2016-01-01$173.24$80.10RVU16A
2015-10-01$172.90$78.91RVU15D
2015-07-01$172.90$78.91RVU15C
2015-04-01$172.04$78.52RVU15B
2015-01-01$172.04$78.52RVU15A
2014-10-01$169.79$78.57RVU14D
2014-07-01$169.79$78.57RVU14C
2014-04-01$169.79$78.57RVU14B
2014-01-01$169.79$78.57RVU14A
2013-10-01$167.51$76.85RVU13D
2013-07-01$167.51$76.85RVU13C
2013-04-01$167.51$76.85RVU13B
2013-01-01$167.51$76.85RVU13AR

Price 45309 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 45309PPRRVU2026_Oct_nonQPP.csv, line 5,492 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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