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CPT code 45317: Bleeding control, rigid proctosigmoidoscopy2026 Medicare rate & RVUs in King County, WA

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 King County, WA, Medicare pays $279.62 for 45317 in the office and $110.77 when it’s performed in a hospital or facility.

$279.62Office (non-facility)
$110.77Hospital or facility
+16.4%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 King County, WA
  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 King County, WA 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. King County, WA pays $279.62. The RVUs are the same everywhere; the geographic indexes change the dollars.

45317 in King County, WA vs other payment areas
  1. King County, WA · this page$279.62
  2. Rest of Washington · Washington$247.48−$32.14
  3. Los Angeles, CA · California$270.13−$9.49
  4. Washington, DC area · District of Columbia$274.59−$5.03
  5. Miami, FL · Florida$262.38−$17.24
  6. Chicago, IL · Illinois$254.40−$25.22
  7. Manhattan, NY · New York$277.25−$2.37

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

Every other payment area

45317 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$277.49$130.93
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

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 King County, WA 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

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 45317 in King County, WA
ComponentRVULocality factorAdjusted
Physician work1.85× 1.0501.9425
Practice expense5.04× 1.2276.1841
Malpractice0.30× 0.8170.2451
Total RVUs8.3717
Conversion factor× 33.4009

Office rate, King County, WA$279.62

Office: (1.85 × 1.05 + 5.04 × 1.227 + 0.3 × 0.817) × $33.4009 = $279.62

Facility: (1.85 × 1.05 + 0.92 × 1.227 + 0.3 × 0.817) × $33.4009 = $110.77

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, King County, WA
Same family
45300Proctosigmoidoscopy, rigid, diagnosticRigid diagnostic proctosigmoidoscopy without the bleeding-control treatment.$175.98
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy, rather than hemostasis as the intervention.$234.08
45320Proctosigmoidoscopy, lesion ablationRigid proctosigmoidoscopy with ablation; distinguish the documented therapeutic service.$286.05
Used instead
45334Flexible sigmoidoscopy, endoscopic bleeding controlFlexible sigmoidoscopy with bleeding control when the flexible instrument and examination are documented.$653.07

How 45317 has changed in King County, WA

45317 · Office / nonfacility

$279.62

Effective 2026-10-01

The base rate is $37.04 higher than on 2025-10-01, moving from $242.58 to $279.62 (15.3%).

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

    $242.58changed to$279.62

    • 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 1.043 changed to 1.050
    • Practice expense GPCI 1.220 changed to 1.227
    • Malpractice GPCI 0.853 changed to 0.817

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $254.39changed to$242.58

    • 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

    $250.24changed to$254.39

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $258.00changed to$250.24

    • 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 1.039 changed to 1.043
    • Practice expense GPCI 1.207 changed to 1.220
    • Malpractice GPCI 0.815 changed to 0.853

  5. January 1, 2023

    RVU23A

    $262.55changed to$258.00

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.53 changed to 4.49
    • Work GPCI 1.036 changed to 1.039
    • Practice expense GPCI 1.194 changed to 1.207
    • Malpractice GPCI 0.776 changed to 0.815

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $258.62changed to$262.55

    • 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

    $231.34changed to$258.62

    • 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 1.031 changed to 1.036
    • Practice expense GPCI 1.170 changed to 1.194
    • Malpractice GPCI 0.854 changed to 0.776

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $217.43changed to$231.34

    • 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 1.027 changed to 1.031
    • Practice expense GPCI 1.146 changed to 1.170
    • Malpractice GPCI 0.931 changed to 0.854

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $206.54changed to$217.43

    • 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. January 1, 2018

    RVU18AR1

    $201.40changed to$206.54

    • 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 1.026 changed to 1.027
    • Practice expense GPCI 1.151 changed to 1.146
    • Malpractice GPCI 0.713 changed to 0.931

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $269.48changed to$201.40

    • 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
    • Work GPCI 1.025 changed to 1.026
    • Practice expense GPCI 1.155 changed to 1.151
    • Malpractice GPCI 0.495 changed to 0.713

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $270.92changed to$269.48

    • 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.

  13. July 1, 2015

    RVU15C

    $269.57changed to$270.92

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $272.06changed to$269.57

    • 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 1.150 changed to 1.155
    • Malpractice GPCI 0.688 changed to 0.495

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $282.42changed to$272.06

    • 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 1.144 changed to 1.150
    • Malpractice GPCI 0.881 changed to 0.688

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $282.42

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$279.62$110.77RVU26D
2026-07-01$279.62$110.77RVU26C
2026-04-01$279.62$110.77RVU26B
2026-01-01$279.62$110.77RVU26A
2025-10-01$242.58$116.70RVU25D
2025-07-01$242.58$116.70RVU25C
2025-04-01$242.58$116.70RVU25B
2025-01-01$242.58$116.70RVU25A
2024-10-01$254.39$119.56RVU24D
2024-07-01$254.39$119.56RVU24C
2024-04-01$254.39$119.56RVU24B
2024-03-09$254.39$119.56RVU24AR
2024-01-01$250.24$117.61RVU24A
2023-10-01$258.00$118.94RVU23D
2023-07-01$258.00$118.94RVU23C
2023-04-01$258.00$118.94RVU23B
2023-01-01$258.00$118.94RVU23A
2022-10-01$262.55$119.58RVU22D
2022-07-01$262.55$119.58RVU22C
2022-04-01$262.55$119.58RVU22B
2022-01-01$262.55$119.58RVU22A
2021-10-01$258.62$119.47RVU21D
2021-07-01$258.62$119.47RVU21C
2021-04-01$258.62$119.47RVU21B
2021-01-01$258.62$119.47RVU21A
2020-10-01$231.34$122.82RVU20D
2020-07-01$231.34$122.82RVU20C
2020-04-01$231.34$122.82RVU20B
2020-01-01$231.34$122.82RVU20A
2019-10-01$217.43$123.26RVU19D
2019-07-01$217.43$123.26RVU19C
2019-04-01$217.43$123.26RVU19B
2019-01-01$217.43$123.26RVU19A
2018-10-01$206.54$123.62RVU18D
2018-07-01$206.54$123.62RVU18C
2018-04-01$206.54$123.62RVU18B
2018-01-01$206.54$123.62RVU18AR1
2017-10-01$201.40$121.27RVU17D
2017-07-01$201.40$121.27RVU17C
2017-04-01$201.40$121.27RVU17B
2017-01-01$201.40$121.27RVU17A
2016-10-01$269.48$123.50RVU16D
2016-07-01$269.48$123.50RVU16C
2016-04-01$269.48$123.50RVU16B
2016-01-01$269.48$123.50RVU16A
2015-10-01$270.92$124.42RVU15D
2015-07-01$270.92$124.42RVU15C
2015-04-01$269.57$123.80RVU15B
2015-01-01$269.57$123.80RVU15A
2014-10-01$272.06$126.64RVU14D
2014-07-01$272.06$126.64RVU14C
2014-04-01$272.06$126.64RVU14B
2014-01-01$272.06$126.64RVU14A
2013-10-01$282.42$127.12RVU13D
2013-07-01$282.42$127.12RVU13C
2013-04-01$282.42$127.12RVU13B
2013-01-01$282.42$127.12RVU13AR

Price 45317 for an earlier date of service

Where the King County, WA rate applies

King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.

  • Seattle
  • Algona
  • Ames Lake
  • 45317 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

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 King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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