FeeBase
Log inGet started
Menu

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

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 Virginia, Medicare pays $227.51 for 45309 in the office and $82.06 when it’s performed in a hospital or facility.

$227.51Office (non-facility)
$82.06Hospital or facility
−2.8%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 Virginia
  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 Virginia 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. Virginia pays $227.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

45309 in Virginia vs other payment areas
  1. Virginia · this page$227.51
  2. Los Angeles, CA · California$264.08+$36.57
  3. Washington, DC area · District of Columbia$269.34+$41.83
  4. Miami, FL · Florida$260.25+$32.74
  5. Chicago, IL · Illinois$251.34+$23.83
  6. Manhattan, NY · New York$272.83+$45.32
  7. Alaska · Alaska$262.91+$35.40

Other areas in Virginia 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 45309 in Virginia
ComponentRVULocality factorAdjusted
Physician work1.37× 1.0001.3700
Practice expense5.27× 0.9835.1804
Malpractice0.37× 0.7060.2612
Total RVUs6.8116
Conversion factor× 33.4009

Office rate, Virginia$227.51

Office: (1.37 × 1 + 5.27 × 0.983 + 0.37 × 0.706) × $33.4009 = $227.51

Facility: (1.37 × 1 + 0.84 × 0.983 + 0.37 × 0.706) × $33.4009 = $82.06

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, Virginia
Used instead
45308Lesion removal, rigid scope, cautery techniqueRigid proctosigmoidoscopy lesion removal using hot biopsy forceps or bipolar cautery.$220.75
45338Flexible sigmoidoscopy, snare lesion removalFlexible sigmoidoscopy with snare removal rather than rigid proctosigmoidoscopy.$328.14
45300Proctosigmoidoscopy, rigid, diagnosticRigid diagnostic proctosigmoidoscopy without the snare-removal service.$145.35
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy rather than snare removal.$193.81
Same family
45315Proctosigmoidoscopy, snare removal of lesionRigid proctosigmoidoscopy with removal of multiple lesions by hot biopsy forceps.$243.87

How 45309 has changed in Virginia

45309 · Office / nonfacility

$227.51

Effective 2026-10-01

The base rate is $30.43 higher than on 2025-10-01, moving from $197.08 to $227.51 (15.4%).

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

    $197.08changed to$227.51

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $205.43changed to$197.08

    • 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

    $202.08changed to$205.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $212.57changed to$202.08

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $222.22changed to$212.57

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $219.54changed to$222.22

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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $193.58changed to$219.54

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.69 changed to 4.61
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $181.33changed to$193.58

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.37 changed to 3.69
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $169.80changed to$181.33

    • 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.

  10. January 1, 2018

    RVU18AR1

    $166.86changed to$169.80

    • 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 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $225.58changed to$166.86

    • 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 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $222.96changed to$225.58

    • 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.

  13. July 1, 2015

    RVU15C

    $221.85changed to$222.96

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $221.77changed to$221.85

    • 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 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $222.29changed to$221.77

    • 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 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $222.29

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$227.51$82.06RVU26D
2026-07-01$227.51$82.06RVU26C
2026-04-01$227.51$82.06RVU26B
2026-01-01$227.51$82.06RVU26A
2025-10-01$197.08$84.72RVU25D
2025-07-01$197.08$84.72RVU25C
2025-04-01$197.08$84.72RVU25B
2025-01-01$197.08$84.72RVU25A
2024-10-01$205.43$86.21RVU24D
2024-07-01$205.43$86.21RVU24C
2024-04-01$205.43$86.21RVU24B
2024-03-09$205.43$86.21RVU24AR
2024-01-01$202.08$84.80RVU24A
2023-10-01$212.57$88.10RVU23D
2023-07-01$212.57$88.10RVU23C
2023-04-01$212.57$88.10RVU23B
2023-01-01$212.57$88.10RVU23A
2022-10-01$222.22$89.99RVU22D
2022-07-01$222.22$89.99RVU22C
2022-04-01$222.22$89.99RVU22B
2022-01-01$222.22$89.99RVU22A
2021-10-01$219.54$90.39RVU21D
2021-07-01$219.54$90.39RVU21C
2021-04-01$219.54$90.39RVU21B
2021-01-01$219.54$90.39RVU21A
2020-10-01$193.58$92.36RVU20D
2020-07-01$193.58$92.36RVU20C
2020-04-01$193.58$92.36RVU20B
2020-01-01$193.58$92.36RVU20A
2019-10-01$181.33$91.79RVU19D
2019-07-01$181.33$91.79RVU19C
2019-04-01$181.33$91.79RVU19B
2019-01-01$181.33$91.79RVU19A
2018-10-01$169.80$91.71RVU18D
2018-07-01$169.80$91.71RVU18C
2018-04-01$169.80$91.71RVU18B
2018-01-01$169.80$91.71RVU18AR1
2017-10-01$166.86$91.21RVU17D
2017-07-01$166.86$91.21RVU17C
2017-04-01$166.86$91.21RVU17B
2017-01-01$166.86$91.21RVU17A
2016-10-01$225.58$95.71RVU16D
2016-07-01$225.58$95.71RVU16C
2016-04-01$225.58$95.71RVU16B
2016-01-01$225.58$95.71RVU16A
2015-10-01$222.96$91.91RVU15D
2015-07-01$222.96$91.91RVU15C
2015-04-01$221.85$91.45RVU15B
2015-01-01$221.85$91.45RVU15A
2014-10-01$221.77$92.58RVU14D
2014-07-01$221.77$92.58RVU14C
2014-04-01$221.77$92.58RVU14B
2014-01-01$221.77$92.58RVU14A
2013-10-01$222.29$91.65RVU13D
2013-07-01$222.29$91.65RVU13C
2013-04-01$222.29$91.65RVU13B
2013-01-01$222.29$91.65RVU13AR

Price 45309 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 45309 pays in Virginia?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 45309 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet