FeeBase
Log inGet started
Menu

CPT code 45317: Bleeding control, rigid proctosigmoidoscopy2026 Medicare rate & RVUs in Puerto Rico

Reports rigid proctosigmoidoscopy used to locate and treat active bleeding in the rectum or distal sigmoid with endoscopic hemostasis.

CMS RVU26DEffective Oct 1, 2026One payment locality220 Medicare services in 2024

In Puerto Rico, Medicare pays $241.85 for 45317 in the office and $102.73 when it’s performed in a hospital or facility.

$241.85Office (non-facility)
$102.73Hospital or facility
+0.7%vs the national office rate ($240.15)

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.

We’ll open 45317 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 45317 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 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 Puerto Rico 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. Puerto Rico pays $241.85. The RVUs are the same everywhere; the geographic indexes change the dollars.

45317 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$241.85
  2. Los Angeles, CA · California$270.13+$28.28
  3. Washington, DC area · District of Columbia$274.59+$32.74
  4. Miami, FL · Florida$262.38+$20.53
  5. Chicago, IL · Illinois$254.40+$12.55
  6. Manhattan, NY · New York$277.25+$35.40
  7. Alaska · Alaska$277.49+$35.64

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

Every other payment area

45317 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$214.76$94.35
ArkansasArkansas$211.56$93.35
ArizonaArizona$233.49$100.15
Bakersfield, CACalifornia$253.57$102.75
Chico, CACalifornia$252.71$101.89
El Centro, CACalifornia$252.76$101.94
Fresno, CACalifornia$252.71$101.89
Hanford, CACalifornia$252.71$101.89

45317 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.

$211.56

$284.71

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

View every state and territory as a table
45317 office rate range by state
State / territoryOffice rate rangeLocalities
AK$277.491
AL$214.761
AR$211.561
AZ$233.491
CA$252.71–$316.7129
CO$249.471
CT$256.451
DC$274.591
DE$237.431
FL$237.79–$262.383
GA$223.90–$245.052
GU$259.001
HI$259.001
IA$219.801
ID$221.401
IL$231.15–$254.404
IN$222.711
KS$219.021
KY$220.611
LA$220.37–$231.582
MA$248.03–$274.242
MD$241.97–$274.593
ME$222.90–$234.942
MI$226.80–$241.132
MN$237.981
MO$216.66–$232.093
MS$214.141
MT$240.131
NC$225.261
ND$234.201
NE$220.961
NH$245.801
NJ$259.08–$271.662
NM$228.191
NV$238.651
NY$228.76–$284.515
OH$225.591
OK$219.911
OR$236.50–$257.262
PA$225.80–$250.102
PR$241.851
RI$245.801
SC$225.861
SD$233.501
TN$220.191
TX$224.29–$248.908
UT$229.031
VA$234.34–$274.592
VI$241.851
VT$233.521
WA$247.48–$279.622
WI$226.151
WV$222.421
WY$237.551

See 45317 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 45317 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.85× 1.0001.8500
Practice expense5.04× 1.0115.0954
Malpractice0.30× 0.9850.2955
Total RVUs7.2409
Conversion factor× 33.4009

Office rate, Puerto Rico$241.85

Office: (1.85 × 1 + 5.04 × 1.011 + 0.3 × 0.985) × $33.4009 = $241.85

Facility: (1.85 × 1 + 0.92 × 1.011 + 0.3 × 0.985) × $33.4009 = $102.73

Open 45317 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 45317

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

Codes related to 45317
CodeHow it relatesOffice range, Puerto Rico
Same family
45300Proctosigmoidoscopy, rigid, diagnosticRigid diagnostic proctosigmoidoscopy without the bleeding-control treatment.$149.87
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy, rather than hemostasis as the intervention.$200.00
45320Proctosigmoidoscopy, lesion ablationRigid proctosigmoidoscopy with ablation; distinguish the documented therapeutic service.$247.56
Used instead
45334Flexible sigmoidoscopy, endoscopic bleeding controlFlexible sigmoidoscopy with bleeding control when the flexible instrument and examination are documented.$549.18

How 45317 has changed in Puerto Rico

45317 · Office / nonfacility

$241.85

Effective 2026-10-01

The base rate is $30.46 higher than on 2025-10-01, moving from $211.39 to $241.85 (14.4%).

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

    $211.39changed to$241.85

    • 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
    • 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

    $221.55changed to$211.39

    • 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.

  3. March 9, 2024

    RVU24AR

    $217.93changed to$221.55

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $226.76changed to$217.93

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $225.69changed to$226.76

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

  6. January 1, 2023

    RVU23A

    $232.98changed to$225.69

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.53 changed to 4.49
    • 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

    $229.65changed to$232.98

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $209.52changed to$229.65

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $199.66changed to$209.52

    • 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
    • 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

    $190.02changed to$199.66

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $167.19changed to$190.02

    • 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
    • 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

    $191.18changed to$167.19

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.00 changed to 1.90
    • Practice expense RVU 4.60 changed to 2.99
    • Malpractice RVU 0.33 changed to 0.31
    • 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

    $192.17changed to$191.18

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.62 changed to 4.60
    • Malpractice RVU 0.31 changed to 0.33

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $191.21changed to$192.17

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $189.53changed to$191.21

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.63 changed to 4.62
    • Malpractice RVU 0.32 changed to 0.31
    • 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

    $191.02changed to$189.53

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.21 changed to 4.63
    • Malpractice RVU 0.33 changed to 0.32
    • 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: $191.02

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$241.85$102.73RVU26D
2026-07-01$241.85$102.73RVU26C
2026-04-01$241.85$102.73RVU26B
2026-01-01$241.85$102.73RVU26A
2025-10-01$211.39$107.48RVU25D
2025-07-01$211.39$107.48RVU25C
2025-04-01$211.39$107.48RVU25B
2025-01-01$211.39$107.48RVU25A
2024-10-01$221.55$110.26RVU24D
2024-07-01$221.55$110.26RVU24C
2024-04-01$221.55$110.26RVU24B
2024-03-09$221.55$110.26RVU24AR
2024-01-01$217.93$108.46RVU24A
2023-10-01$226.76$110.62RVU23D
2023-07-01$225.69$110.47RVU23C
2023-04-01$225.69$110.47RVU23B
2023-01-01$225.69$110.47RVU23A
2022-10-01$232.98$112.29RVU22D
2022-07-01$232.98$112.29RVU22C
2022-04-01$232.98$112.29RVU22B
2022-01-01$232.98$112.29RVU22A
2021-10-01$229.65$112.17RVU21D
2021-07-01$229.65$112.17RVU21C
2021-04-01$229.65$112.17RVU21B
2021-01-01$229.65$112.17RVU21A
2020-10-01$209.52$116.02RVU20D
2020-07-01$209.52$116.02RVU20C
2020-04-01$209.52$116.02RVU20B
2020-01-01$209.52$116.02RVU20A
2019-10-01$199.66$116.91RVU19D
2019-07-01$199.66$116.91RVU19C
2019-04-01$199.66$116.91RVU19B
2019-01-01$199.66$116.91RVU19A
2018-10-01$190.02$117.16RVU18D
2018-07-01$190.02$117.16RVU18C
2018-04-01$190.02$117.16RVU18B
2018-01-01$190.02$117.16RVU18AR1
2017-10-01$167.19$107.59RVU17D
2017-07-01$167.19$107.59RVU17C
2017-04-01$167.19$107.59RVU17B
2017-01-01$167.19$107.59RVU17A
2016-10-01$191.18$102.08RVU16D
2016-07-01$191.18$102.08RVU16C
2016-04-01$191.18$102.08RVU16B
2016-01-01$191.18$102.08RVU16A
2015-10-01$192.17$102.74RVU15D
2015-07-01$192.17$102.74RVU15C
2015-04-01$191.21$102.23RVU15B
2015-01-01$191.21$102.23RVU15A
2014-10-01$189.53$102.02RVU14D
2014-07-01$189.53$102.02RVU14C
2014-04-01$189.53$102.02RVU14B
2014-01-01$189.53$102.02RVU14A
2013-10-01$191.02$98.98RVU13D
2013-07-01$191.02$98.98RVU13C
2013-04-01$191.02$98.98RVU13B
2013-01-01$191.02$98.98RVU13AR

Price 45317 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

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
RVUs for 45317PPRRVU2026_Oct_nonQPP.csv, line 5,494 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 45317 pays in Puerto Rico?

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

Fee sheets

Put 45317 and the rest of your codes on one sheet

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

Build my fee sheet