CPT code 45317: Bleeding control, rigid proctosigmoidoscopy2026 Medicare rate & RVUs in Marin County, CA
Reports rigid proctosigmoidoscopy used to locate and treat active bleeding in the rectum or distal sigmoid with endoscopic hemostasis.
In Marin County, CA, Medicare pays $309.62 for 45317 in the office and $115.59 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45317 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 45317 covers
A clinician advances a rigid proctosigmoidoscope through the anus to examine the rectum and distal sigmoid and treat a bleeding site. A gastroenterologist or colorectal surgeon may perform the service in an office, outpatient endoscopy unit, or hospital setting. Hemostasis may use an endoscopic technique such as cautery, injection, or another method suited to the bleeding source.
Report this code when the rigid examination includes active treatment to control bleeding, rather than a diagnostic examination alone. The procedure note should identify the bleeding site, the intervention used, and the result. 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. Bilateral adjustment is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery 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 Marin County, CA compares for 45317
Across 109 of 109 payment localities, the office rate for 45317 runs from $211.56 in Arkansas to $316.71 in San Benito County, CA. Marin County, CA pays $309.62. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Marin County, CA · this page$309.62
- Bakersfield, CA · California$253.57−$56.05
- Chico, CA · California$252.71−$56.91
- El Centro, CA · California$252.76−$56.86
- Fresno, CA · California$252.71−$56.91
- Hanford, CA · California$252.71−$56.91
- Los Angeles, CA · California$270.13−$39.49
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $252.71 | $101.89 |
| Merced, CACalifornia | $252.71 | $101.89 |
| Modesto, CACalifornia | $252.71 | $101.89 |
| Napa, CACalifornia | $292.65 | $111.28 |
| Oxnard, CACalifornia | $268.74 | $106.09 |
| Redding, CACalifornia | $252.71 | $101.89 |
| Rest of CaliforniaCalifornia | $252.71 | $101.89 |
| Riverside, CACalifornia | $255.95 | $105.13 |
| Sacramento, CACalifornia | $265.17 | $105.12 |
| Salinas, CACalifornia | $264.18 | $104.69 |
| San Diego, CACalifornia | $270.41 | $105.83 |
| San Francisco, CACalifornia | $309.28 | $115.25 |
| San Benito County, CACalifornia | $316.71 | $118.27 |
| Santa Clara County, CACalifornia | $315.31 | $116.88 |
| San Luis Obispo, CACalifornia | $259.95 | $103.21 |
| Santa Cruz, CACalifornia | $272.99 | $105.80 |
| Santa Maria, CACalifornia | $265.18 | $104.72 |
| Santa Rosa, CACalifornia | $275.74 | $106.75 |
| Stockton, CACalifornia | $252.71 | $101.89 |
| Vallejo, CACalifornia | $292.16 | $110.78 |
| Visalia, CACalifornia | $252.71 | $101.89 |
| Yuba City, CACalifornia | $252.71 | $101.89 |
| Washington, DC areaDistrict of Columbia | $274.59 | $112.48 |
| Miami, FLFlorida | $262.38 | $119.12 |
| Chicago, ILIllinois | $254.40 | $116.10 |
| Manhattan, NYNew York | $277.25 | $117.35 |
| AlaskaAlaska | $277.49 | $130.93 |
| AlabamaAlabama | $214.76 | $94.35 |
| ArkansasArkansas | $211.56 | $93.35 |
| ArizonaArizona | $233.49 | $100.15 |
| ColoradoColorado | $249.47 | $103.05 |
| ConnecticutConnecticut | $256.45 | $108.25 |
| DelawareDelaware | $237.43 | $101.47 |
| Fort Lauderdale, FLFlorida | $250.44 | $111.04 |
| Rest of FloridaFlorida | $237.79 | $106.23 |
| Atlanta, GAGeorgia | $245.05 | $105.23 |
| Rest of GeorgiaGeorgia | $223.90 | $101.15 |
| Hawaii, Guam, HIHawaii | $259.00 | $102.53 |
| IowaIowa | $219.80 | $93.89 |
| IdahoIdaho | $221.40 | $94.80 |
| East St. Louis, ILIllinois | $236.85 | $110.24 |
| Rest of IllinoisIllinois | $231.15 | $105.51 |
| Suburban Chicago, ILIllinois | $252.87 | $111.54 |
| IndianaIndiana | $222.71 | $95.15 |
| KansasKansas | $219.02 | $94.62 |
| KentuckyKentucky | $220.61 | $98.28 |
| New Orleans, LALouisiana | $231.58 | $102.09 |
| Rest of LouisianaLouisiana | $220.37 | $98.59 |
| Metropolitan Boston, MAMassachusetts | $274.24 | $109.93 |
| Rest of MassachusettsMassachusetts | $248.03 | $103.12 |
| Baltimore area, MDMaryland | $255.80 | $108.15 |
| Rest of MarylandMaryland | $241.97 | $102.71 |
| Rest of MaineMaine | $222.90 | $96.29 |
| Southern Maine, MEMaine | $234.94 | $98.57 |
| Detroit, MIMichigan | $241.13 | $108.34 |
| Rest of MichiganMichigan | $226.80 | $101.16 |
| MinnesotaMinnesota | $237.98 | $96.38 |
| Metropolitan Kansas City, MOMissouri | $229.65 | $100.44 |
| Metropolitan St. Louis, MOMissouri | $232.09 | $101.09 |
| Rest of MissouriMissouri | $216.66 | $98.04 |
| MississippiMississippi | $214.14 | $95.65 |
| MontanaMontana | $240.13 | $102.52 |
| North CarolinaNorth Carolina | $225.26 | $96.86 |
| North DakotaNorth Dakota | $234.20 | $96.59 |
| NebraskaNebraska | $220.96 | $93.94 |
| New HampshireNew Hampshire | $245.80 | $102.55 |
| Northern New JerseyNew Jersey | $271.66 | $112.03 |
| Rest of New JerseyNew Jersey | $259.08 | $108.81 |
| New MexicoNew Mexico | $228.19 | $102.00 |
| NevadaNevada | $238.65 | $100.90 |
| NYC suburbs and Long Island, NYNew York | $284.51 | $120.89 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $261.03 | $110.34 |
| Queens, NYNew York | $279.17 | $116.52 |
| Rest of New YorkNew York | $228.76 | $98.03 |
| OhioOhio | $225.59 | $99.95 |
| OklahomaOklahoma | $219.91 | $97.02 |
| Portland, OROregon | $257.26 | $104.38 |
| Rest of OregonOregon | $236.50 | $99.44 |
| Metropolitan Philadelphia, PAPennsylvania | $250.10 | $106.85 |
| Rest of PennsylvaniaPennsylvania | $225.80 | $99.47 |
| Puerto RicoPuerto Rico | $241.85 | $102.73 |
| Rhode IslandRhode Island | $245.80 | $103.65 |
| South CarolinaSouth Carolina | $225.86 | $98.70 |
| South DakotaSouth Dakota | $233.50 | $95.89 |
| TennesseeTennessee | $220.19 | $95.11 |
| Austin, TXTexas | $248.90 | $103.30 |
| Beaumont, TXTexas | $224.29 | $99.06 |
| Brazoria, TXTexas | $236.93 | $100.55 |
| Dallas, TXTexas | $238.61 | $101.55 |
| Fort Worth, TXTexas | $237.06 | $101.37 |
| Galveston, TXTexas | $237.74 | $101.10 |
| Houston, TXTexas | $243.24 | $106.59 |
| Rest of TexasTexas | $230.60 | $100.00 |
| UtahUtah | $229.03 | $99.67 |
| VirginiaVirginia | $234.34 | $99.07 |
| Virgin Islands, VIUnited States Virgin Islands | $241.85 | $102.73 |
| VermontVermont | $233.52 | $97.28 |
| Rest of WashingtonWashington | $247.48 | $102.58 |
| King County, WAWashington | $279.62 | $110.77 |
| WisconsinWisconsin | $226.15 | $94.32 |
| West VirginiaWest Virginia | $222.42 | $102.83 |
| WyomingWyoming | $237.55 | $99.94 |
45317 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.
$211.56
$284.71
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 | $277.49 | 1 |
| AL | $214.76 | 1 |
| AR | $211.56 | 1 |
| AZ | $233.49 | 1 |
| CA | $252.71–$316.71 | 29 |
| CO | $249.47 | 1 |
| CT | $256.45 | 1 |
| DC | $274.59 | 1 |
| DE | $237.43 | 1 |
| FL | $237.79–$262.38 | 3 |
| GA | $223.90–$245.05 | 2 |
| GU | $259.00 | 1 |
| HI | $259.00 | 1 |
| IA | $219.80 | 1 |
| ID | $221.40 | 1 |
| IL | $231.15–$254.40 | 4 |
| IN | $222.71 | 1 |
| KS | $219.02 | 1 |
| KY | $220.61 | 1 |
| LA | $220.37–$231.58 | 2 |
| MA | $248.03–$274.24 | 2 |
| MD | $241.97–$274.59 | 3 |
| ME | $222.90–$234.94 | 2 |
| MI | $226.80–$241.13 | 2 |
| MN | $237.98 | 1 |
| MO | $216.66–$232.09 | 3 |
| MS | $214.14 | 1 |
| MT | $240.13 | 1 |
| NC | $225.26 | 1 |
| ND | $234.20 | 1 |
| NE | $220.96 | 1 |
| NH | $245.80 | 1 |
| NJ | $259.08–$271.66 | 2 |
| NM | $228.19 | 1 |
| NV | $238.65 | 1 |
| NY | $228.76–$284.51 | 5 |
| OH | $225.59 | 1 |
| OK | $219.91 | 1 |
| OR | $236.50–$257.26 | 2 |
| PA | $225.80–$250.10 | 2 |
| PR | $241.85 | 1 |
| RI | $245.80 | 1 |
| SC | $225.86 | 1 |
| SD | $233.50 | 1 |
| TN | $220.19 | 1 |
| TX | $224.29–$248.90 | 8 |
| UT | $229.03 | 1 |
| VA | $234.34–$274.59 | 2 |
| VI | $241.85 | 1 |
| VT | $233.52 | 1 |
| WA | $247.48–$279.62 | 2 |
| WI | $226.15 | 1 |
| WV | $222.42 | 1 |
| WY | $237.55 | 1 |
How the 45317 rate is calculated
Each of 45317’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 · 45317
RVUs × geographic indexes × conversion factor
Work1.85
1.85 RVUs× 1.000 GPCI
Practice expense5.04
5.04 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
7.1900
Conversion factor
$33.4009
Medicare rate
$240.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Marin County, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,494
- Code
- 45317
- Physician work
- 1.85
- Practice expense
- 5.04
- Malpractice
- 0.30
GPCI2026.csv
25
- Locality
- Marin County, CA
- Physician work
- 1.095
- Practice expense
- 1.410
- Malpractice
- 0.459
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.85 | × 1.095 | 2.0257 |
| Practice expense | 5.04 | × 1.410 | 7.1064 |
| Malpractice | 0.30 | × 0.459 | 0.1377 |
| Total RVUs | 9.2698 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Marin County, CA$309.62
Office: (1.85 × 1.095 + 5.04 × 1.41 + 0.3 × 0.459) × $33.4009 = $309.62
Facility: (1.85 × 1.095 + 0.92 × 1.41 + 0.3 × 0.459) × $33.4009 = $115.59
Payment rules and modifiers for 45317
The CMS indicators that decide how 45317 is paid alongside other services.
CMS payment indicators · 45317
Bleeding control, rigid proctosigmoidoscopy
| 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
45317 without 51 · national office
$240.15
Bleeding control, rigid proctosigmoidoscopy
45317-51 · Second procedure: 50%
$120.08
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%).
How 45317 has changed in Marin County, CA
45317 · Office / nonfacility
$309.62
Effective 2026-10-01
The base rate is $40.06 higher than on 2025-10-01, moving from $269.56 to $309.62 (14.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$269.56changed to$309.62
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.90 changed to 1.85
- Practice expense RVU 4.32 changed to 5.04
- Malpractice RVU 0.29 changed to 0.30
- Work GPCI 1.088 changed to 1.095
- Practice expense GPCI 1.419 changed to 1.410
- Malpractice GPCI 0.470 changed to 0.459
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$282.76changed to$269.56
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.43 changed to 4.32
- Malpractice RVU 0.30 changed to 0.29
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$278.14changed to$282.76
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$283.18changed to$278.14
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.49 changed to 4.43
- Malpractice RVU 0.27 changed to 0.30
- Work GPCI 1.082 changed to 1.088
- Practice expense GPCI 1.374 changed to 1.419
- Malpractice GPCI 0.487 changed to 0.470
January 1, 2023
RVU23A
$283.87changed to$283.18
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.53 changed to 4.49
- Work GPCI 1.077 changed to 1.082
- Practice expense GPCI 1.329 changed to 1.374
- Malpractice GPCI 0.504 changed to 0.487
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$276.40changed to$283.87
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.39 changed to 4.53
- Malpractice RVU 0.26 changed to 0.27
- Work GPCI 1.071 changed to 1.077
- Practice expense GPCI 1.311 changed to 1.329
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$246.86changed to$276.40
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.60 changed to 4.39
- Malpractice RVU 0.28 changed to 0.26
- Work GPCI 1.068 changed to 1.071
- Practice expense GPCI 1.299 changed to 1.311
- Malpractice GPCI 0.481 changed to 0.504
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$232.04changed to$246.86
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.31 changed to 3.60
- Malpractice RVU 0.31 changed to 0.28
- Work GPCI 1.065 changed to 1.068
- Practice expense GPCI 1.291 changed to 1.299
- Malpractice GPCI 0.458 changed to 0.481
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$218.48changed to$232.04
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.06 changed to 3.31
- Malpractice RVU 0.30 changed to 0.31
- Work GPCI 1.062 changed to 1.065
- Practice expense GPCI 1.279 changed to 1.291
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$213.84changed to$218.48
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.99 changed to 3.06
- Malpractice RVU 0.31 changed to 0.30
- Work GPCI 1.058 changed to 1.062
- Practice expense GPCI 1.271 changed to 1.279
- Malpractice GPCI 0.477 changed to 0.458
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$213.84
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $309.62 | $115.59 | RVU26D |
| 2026-07-01 | $309.62 | $115.59 | RVU26C |
| 2026-04-01 | $309.62 | $115.59 | RVU26B |
| 2026-01-01 | $309.62 | $115.59 | RVU26A |
| 2025-10-01 | $269.56 | $123.14 | RVU25D |
| 2025-07-01 | $269.56 | $123.14 | RVU25C |
| 2025-04-01 | $269.56 | $123.14 | RVU25B |
| 2025-01-01 | $269.56 | $123.14 | RVU25A |
| 2024-10-01 | $282.76 | $125.94 | RVU24D |
| 2024-07-01 | $282.76 | $125.94 | RVU24C |
| 2024-04-01 | $282.76 | $125.94 | RVU24B |
| 2024-03-09 | $282.76 | $125.94 | RVU24AR |
| 2024-01-01 | $278.14 | $123.88 | RVU24A |
| 2023-10-01 | $283.18 | $124.87 | RVU23D |
| 2023-07-01 | $283.18 | $124.87 | RVU23C |
| 2023-04-01 | $283.18 | $124.87 | RVU23B |
| 2023-01-01 | $283.18 | $124.87 | RVU23A |
| 2022-10-01 | $283.87 | $124.73 | RVU22D |
| 2022-07-01 | $283.87 | $124.73 | RVU22C |
| 2022-04-01 | $283.87 | $124.73 | RVU22B |
| 2022-01-01 | $283.87 | $124.73 | RVU22A |
| 2021-10-01 | $276.40 | $123.61 | RVU21D |
| 2021-07-01 | $276.40 | $123.61 | RVU21C |
| 2021-04-01 | $276.40 | $123.61 | RVU21B |
| 2021-01-01 | $276.40 | $123.61 | RVU21A |
| 2020-10-01 | $246.86 | $126.38 | RVU20D |
| 2020-07-01 | $246.86 | $126.38 | RVU20C |
| 2020-04-01 | $246.86 | $126.38 | RVU20B |
| 2020-01-01 | $246.86 | $126.38 | RVU20A |
| 2019-10-01 | $232.04 | $125.96 | RVU19D |
| 2019-07-01 | $232.04 | $125.96 | RVU19C |
| 2019-04-01 | $232.04 | $125.96 | RVU19B |
| 2019-01-01 | $232.04 | $125.96 | RVU19A |
| 2018-10-01 | $218.48 | $125.93 | RVU18D |
| 2018-07-01 | $218.48 | $125.93 | RVU18C |
| 2018-04-01 | $218.48 | $125.93 | RVU18B |
| 2018-01-01 | $218.48 | $125.93 | RVU18AR1 |
| 2017-10-01 | $213.84 | $125.35 | RVU17D |
| 2017-07-01 | $213.84 | $125.35 | RVU17C |
| 2017-04-01 | $213.84 | $125.35 | RVU17B |
| 2017-01-01 | $213.84 | $125.35 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Marin County, CA rate applies
Marin County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 31 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Alto
- Belvedere
- Black Point-Green Point
- Bolinas
- Corte Madera
- Dillon Beach
- Fairfax
- Inverness
45317 billing questions
How is this different from diagnostic proctosigmoidoscopy?
45317 includes endoscopic treatment to control bleeding. Use the diagnostic code when the rigid examination is performed without bleeding-control treatment.
How does this differ from 45334?
Both address endoscopic control of bleeding, but 45317 is for rigid proctosigmoidoscopy and 45334 is for flexible sigmoidoscopy. Choose according to the instrument and examination documented.
Can the diagnostic examination be billed separately?
The diagnostic examination that leads to bleeding-control treatment is part of the therapeutic endoscopy. Document the treatment performed and the bleeding site.
Should modifier 50 be appended?
No. The anatomy and service make bilateral adjustment inappropriate.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document each procedure and its distinct clinical purpose.
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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