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

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 Tennessee, Medicare pays $220.19 for 45317 in the office and $95.11 when it’s performed in a hospital or facility.

$220.19Office (non-facility)
$95.11Hospital or facility
−8.3%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 Tennessee
  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 Tennessee 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. Tennessee pays $220.19. The RVUs are the same everywhere; the geographic indexes change the dollars.

45317 in Tennessee vs other payment areas
  1. Tennessee · this page$220.19
  2. Los Angeles, CA · California$270.13+$49.94
  3. Washington, DC area · District of Columbia$274.59+$54.40
  4. Miami, FL · Florida$262.38+$42.19
  5. Chicago, IL · Illinois$254.40+$34.21
  6. Manhattan, NY · New York$277.25+$57.06
  7. Alaska · Alaska$277.49+$57.30

Other areas in Tennessee 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 Tennessee 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

95

Locality
Tennessee
Physician work
1.000
Practice expense
0.909
Malpractice
0.537
Office calculation for 45317 in Tennessee
ComponentRVULocality factorAdjusted
Physician work1.85× 1.0001.8500
Practice expense5.04× 0.9094.5814
Malpractice0.30× 0.5370.1611
Total RVUs6.5925
Conversion factor× 33.4009

Office rate, Tennessee$220.19

Office: (1.85 × 1 + 5.04 × 0.909 + 0.3 × 0.537) × $33.4009 = $220.19

Facility: (1.85 × 1 + 0.92 × 0.909 + 0.3 × 0.537) × $33.4009 = $95.11

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, Tennessee
Same family
45300Proctosigmoidoscopy, rigid, diagnosticRigid diagnostic proctosigmoidoscopy without the bleeding-control treatment.$135.86
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy, rather than hemostasis as the intervention.$181.27
45320Proctosigmoidoscopy, lesion ablationRigid proctosigmoidoscopy with ablation; distinguish the documented therapeutic service.$223.10
Used instead
45334Flexible sigmoidoscopy, endoscopic bleeding controlFlexible sigmoidoscopy with bleeding control when the flexible instrument and examination are documented.$497.78

How 45317 has changed in Tennessee

45317 · Office / nonfacility

$220.19

Effective 2026-10-01

The base rate is $28.42 higher than on 2025-10-01, moving from $191.77 to $220.19 (14.8%).

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

    $191.77changed to$220.19

    • 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 0.896 changed to 0.909
    • Malpractice GPCI 0.544 changed to 0.537

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $200.81changed to$191.77

    • 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

    $197.53changed to$200.81

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $205.15changed to$197.53

    • 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 0.894 changed to 0.896
    • Malpractice GPCI 0.518 changed to 0.544

  5. January 1, 2023

    RVU23A

    $210.18changed to$205.15

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.53 changed to 4.49
    • Practice expense GPCI 0.892 changed to 0.894
    • Malpractice GPCI 0.492 changed to 0.518

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $207.40changed to$210.18

    • 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.

  7. January 1, 2021

    RVU21A

    $190.25changed to$207.40

    • 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
    • Practice expense GPCI 0.897 changed to 0.892
    • Malpractice GPCI 0.509 changed to 0.492

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $181.83changed to$190.25

    • 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 0.901 changed to 0.897
    • Malpractice GPCI 0.526 changed to 0.509

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $173.33changed to$181.83

    • 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.

  10. April 1, 2018

    RVU18B

    No ratechanged to$173.33

    Held through RVU18C, RVU18D.

  11. 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, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$220.19$95.11RVU26D
2026-07-01$220.19$95.11RVU26C
2026-04-01$220.19$95.11RVU26B
2026-01-01$220.19$95.11RVU26A
2025-10-01$191.77$99.31RVU25D
2025-07-01$191.77$99.31RVU25C
2025-04-01$191.77$99.31RVU25B
2025-01-01$191.77$99.31RVU25A
2024-10-01$200.81$101.79RVU24D
2024-07-01$200.81$101.79RVU24C
2024-04-01$200.81$101.79RVU24B
2024-03-09$200.81$101.79RVU24AR
2024-01-01$197.53$100.12RVU24A
2023-10-01$205.15$102.15RVU23D
2023-07-01$205.15$102.15RVU23C
2023-04-01$205.15$102.15RVU23B
2023-01-01$205.15$102.15RVU23A
2022-10-01$210.18$103.38RVU22D
2022-07-01$210.18$103.38RVU22C
2022-04-01$210.18$103.38RVU22B
2022-01-01$210.18$103.38RVU22A
2021-10-01$207.40$103.44RVU21D
2021-07-01$207.40$103.44RVU21C
2021-04-01$207.40$103.44RVU21B
2021-01-01$207.40$103.44RVU21A
2020-10-01$190.25$107.06RVU20D
2020-07-01$190.25$107.06RVU20C
2020-04-01$190.25$107.06RVU20B
2020-01-01$190.25$107.06RVU20A
2019-10-01$181.83$107.80RVU19D
2019-07-01$181.83$107.80RVU19C
2019-04-01$181.83$107.80RVU19B
2019-01-01$181.83$107.80RVU19A
2018-10-01$173.33$108.14RVU18D
2018-07-01$173.33$108.14RVU18C
2018-04-01$173.33$108.14RVU18B
2018-01-01Rate data unavailableRate data unavailableRVU18AR1
2017-10-01Rate data unavailableRate data unavailableRVU17D
2017-07-01Rate data unavailableRate data unavailableRVU17C
2017-04-01Rate data unavailableRate data unavailableRVU17B
2017-01-01Rate data unavailableRate data unavailableRVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 45317 for an earlier date of service

Where the Tennessee rate applies

Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.

  • Adams
  • Adamsville
  • Alamo
  • Alcoa
  • Alexandria
  • Algood
  • Allardt
  • Altamont

Browse all communities in Tennessee

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 TennesseeGPCI2026.csv, line 95 (RVU26D)

Open CMS sourceHow we calculate rates

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