CPT code 45320: Proctosigmoidoscopy, lesion ablation2026 Medicare rate & RVUs
Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal.
Medicare pays $245.83 for 45320 nationally in the office and $99.53 in a hospital or facility. Local office rates run $213.95–$323.29.
Medicare rate · 45320
Proctosigmoidoscopy, lesion ablation
- Work RVUs
- 1.64
- Total RVUs
- 7.36
- Global days
- 000
National rate · 2026
$245.83
Office setting, before claim adjustments.
See every locality for 45320 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 45320 covers
During rigid proctosigmoidoscopy, the clinician examines the rectum and distal sigmoid through a rigid scope and destroys a tumor, polyp, or other lesion that is not suitable for removal with hot biopsy forceps, bipolar cautery, or a snare. This is a therapeutic procedure rather than inspection or tissue sampling alone. Gastroenterologists and colorectal surgeons may perform it in an endoscopy unit or operating room, depending on access and the patient's needs.
Report 45320 for the ablation service when the documented lesion and treatment fit this rigid-scope procedure; use a removal code when the lesion is excised instead. The procedure note should identify the lesion, its site, and the ablative treatment. 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. Modifier 50 is inappropriate. Assistant-at-surgery payment is barred, and co-surgery 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.
Where 45320 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$213.95 to $323.29
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $217.51 | $89.50 |
| Alaska | $278.26 | $122.45 |
| Arizona | $238.29 | $96.52 |
| Arkansas | $213.95 | $88.28 |
| Atlanta, GA | $251.71 | $103.07 |
| Austin, TX | $254.55 | $99.77 |
| Bakersfield, CA | $258.22 | $97.88 |
| Baltimore area, MD | $263.01 | $106.03 |
| Beaumont, TX | $228.91 | $95.78 |
| Brazoria, TX | $241.52 | $96.54 |
| Chicago, IL | $265.70 | $118.67 |
| Chico, CA | $257.06 | $96.72 |
| Colorado | $254.65 | $98.99 |
| Connecticut | $263.55 | $105.99 |
| Dallas, TX | $243.58 | $97.87 |
| Delaware | $242.53 | $97.99 |
| Detroit, MI | $249.50 | $108.32 |
| East St. Louis, IL | $246.26 | $111.67 |
| El Centro, CA | $257.13 | $96.79 |
| Fort Lauderdale, FL | $259.73 | $111.53 |
| Fort Worth, TX | $242.00 | $97.75 |
| Fresno, CA | $257.06 | $96.72 |
| Galveston, TX | $242.56 | $97.29 |
| Hanford, CA | $257.06 | $96.72 |
| Hawaii, Guam, HI | $263.99 | $97.65 |
| Houston, TX | $250.43 | $105.16 |
| Idaho | $224.13 | $89.53 |
| Indiana | $225.55 | $89.93 |
| Iowa | $222.15 | $88.29 |
| Kansas | $221.74 | $89.49 |
| Kentucky | $225.00 | $94.94 |
| King County, WA | $286.05 | $106.54 |
| Los Angeles, CA | $275.59 | $102.52 |
| Madera, CA | $257.06 | $96.72 |
| Manhattan, NY | $286.38 | $116.38 |
| Marin County, CA | $315.71 | $109.43 |
| Merced, CA | $257.06 | $96.72 |
| Metropolitan Boston, MA | $280.77 | $106.10 |
| Metropolitan Kansas City, MO | $234.72 | $97.35 |
| Metropolitan Philadelphia, PA | $256.83 | $104.54 |
| Metropolitan St. Louis, MO | $237.38 | $98.10 |
| Miami, FL | $275.04 | $122.74 |
| Minnesota | $240.84 | $90.31 |
| Mississippi | $217.52 | $91.56 |
| Modesto, CA | $257.06 | $96.72 |
| Montana | $245.80 | $99.51 |
| Napa, CA | $298.40 | $105.58 |
| Nebraska | $223.29 | $88.26 |
| Nevada | $243.61 | $97.17 |
| New Hampshire | $251.28 | $98.99 |
| New Mexico | $234.05 | $99.90 |
| New Orleans, LA | $237.36 | $99.69 |
| North Carolina | $228.81 | $92.31 |
| North Dakota | $237.30 | $91.00 |
| Northern New Jersey | $278.53 | $108.83 |
| NYC suburbs and Long Island, NY | $295.04 | $121.09 |
| Ohio | $230.57 | $97.01 |
| Oklahoma | $223.72 | $93.08 |
| Oxnard, CA | $274.11 | $101.19 |
| Portland, OR | $262.64 | $100.11 |
| Poughkeepsie and northern NYC suburbs, NY | $268.10 | $107.90 |
| Puerto Rico | $247.56 | $99.65 |
| Queens, NY | $287.84 | $114.92 |
| Redding, CA | $257.06 | $96.72 |
| Rest of California | $257.06 | $96.72 |
| Rest of Florida | $245.28 | $105.42 |
| Rest of Georgia | $229.51 | $99.01 |
| Rest of Illinois | $238.54 | $104.98 |
| Rest of Louisiana | $224.91 | $95.44 |
| Rest of Maine | $226.27 | $91.67 |
| Rest of Maryland | $247.32 | $99.27 |
| Rest of Massachusetts | $253.16 | $99.11 |
| Rest of Michigan | $232.31 | $98.74 |
| Rest of Missouri | $221.07 | $94.97 |
| Rest of New Jersey | $265.67 | $105.92 |
| Rest of New York | $232.73 | $93.75 |
| Rest of Oregon | $240.86 | $95.15 |
| Rest of Pennsylvania | $230.55 | $96.25 |
| Rest of Texas | $235.43 | $96.59 |
| Rest of Washington | $252.47 | $98.43 |
| Rhode Island | $251.15 | $100.03 |
| Riverside, CA | $261.67 | $101.33 |
| Sacramento, CA | $269.94 | $99.80 |
| Salinas, CA | $268.96 | $99.40 |
| San Benito County, CA | $323.29 | $112.33 |
| San Diego, CA | $275.53 | $100.56 |
| San Francisco, CA | $315.22 | $108.94 |
| San Luis Obispo, CA | $264.66 | $98.03 |
| Santa Clara County, CA | $321.29 | $110.33 |
| Santa Cruz, CA | $278.31 | $100.56 |
| Santa Maria, CA | $270.03 | $99.45 |
| Santa Rosa, CA | $281.10 | $101.44 |
| South Carolina | $230.25 | $95.07 |
| South Dakota | $236.29 | $90.00 |
| Southern Maine, ME | $238.94 | $93.96 |
| Stockton, CA | $257.06 | $96.72 |
| Suburban Chicago, IL | $262.07 | $111.83 |
| Tennessee | $223.10 | $90.12 |
| Utah | $233.76 | $96.25 |
| Vallejo, CA | $297.70 | $104.88 |
| Vermont | $236.97 | $92.14 |
| Virgin Islands, VI | $247.56 | $99.65 |
| Virginia | $238.60 | $94.80 |
| Visalia, CA | $257.06 | $96.72 |
| Washington, DC area | $281.86 | $109.53 |
| West Virginia | $228.87 | $101.74 |
| Wisconsin | $228.47 | $88.32 |
| Wyoming | $242.10 | $95.80 |
| Yuba City, CA | $257.06 | $96.72 |
45320 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.
$213.95
$290.18
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 | $278.26 | 1 |
| AL | $217.51 | 1 |
| AR | $213.95 | 1 |
| AZ | $238.29 | 1 |
| CA | $257.06–$323.29 | 29 |
| CO | $254.65 | 1 |
| CT | $263.55 | 1 |
| DC | $281.86 | 1 |
| DE | $242.53 | 1 |
| FL | $245.28–$275.04 | 3 |
| GA | $229.51–$251.71 | 2 |
| GU | $263.99 | 1 |
| HI | $263.99 | 1 |
| IA | $222.15 | 1 |
| ID | $224.13 | 1 |
| IL | $238.54–$265.70 | 4 |
| IN | $225.55 | 1 |
| KS | $221.74 | 1 |
| KY | $225.00 | 1 |
| LA | $224.91–$237.36 | 2 |
| MA | $253.16–$280.77 | 2 |
| MD | $247.32–$281.86 | 3 |
| ME | $226.27–$238.94 | 2 |
| MI | $232.31–$249.50 | 2 |
| MN | $240.84 | 1 |
| MO | $221.07–$237.38 | 3 |
| MS | $217.52 | 1 |
| MT | $245.80 | 1 |
| NC | $228.81 | 1 |
| ND | $237.30 | 1 |
| NE | $223.29 | 1 |
| NH | $251.28 | 1 |
| NJ | $265.67–$278.53 | 2 |
| NM | $234.05 | 1 |
| NV | $243.61 | 1 |
| NY | $232.73–$295.04 | 5 |
| OH | $230.57 | 1 |
| OK | $223.72 | 1 |
| OR | $240.86–$262.64 | 2 |
| PA | $230.55–$256.83 | 2 |
| PR | $247.56 | 1 |
| RI | $251.15 | 1 |
| SC | $230.25 | 1 |
| SD | $236.29 | 1 |
| TN | $223.10 | 1 |
| TX | $228.91–$254.55 | 8 |
| UT | $233.76 | 1 |
| VA | $238.60–$281.86 | 2 |
| VI | $247.56 | 1 |
| VT | $236.97 | 1 |
| WA | $252.47–$286.05 | 2 |
| WI | $228.47 | 1 |
| WV | $228.87 | 1 |
| WY | $242.10 | 1 |
How the 45320 rate is calculated
Each of 45320’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 · 45320
RVUs × geographic indexes × conversion factor
Work1.64
1.64 RVUs× 1.000 GPCI
Practice expense5.29
5.29 RVUs× 1.000 GPCI
Malpractice0.43
0.43 RVUs× 1.000 GPCI
Adjusted RVUs
7.3600
Conversion factor
$33.4009
Medicare rate
$245.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45320
The CMS indicators that decide how 45320 is paid alongside other services.
CMS payment indicators · 45320
Proctosigmoidoscopy, lesion ablation
| 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
45320 without 51 · national office
$245.83
Proctosigmoidoscopy, lesion ablation
45320-51 · Second procedure: 50%
$122.92
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%).
45320 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45308Lesion removalRigid scope, cautery technique
- Use 45308 for lesion removal with hot biopsy forceps or bipolar cautery. Use 45320 when the lesion is ablated rather than removed by that method.
- 45309ProctosigmoidoscopySnare lesion removal
- 45309 describes lesion removal by snare. 45320 describes ablation of a lesion not suitable for conventional removal.
- 45346Flexible sigmoidoscopyLesion ablation
- Both involve lesion ablation; 45320 uses rigid proctosigmoidoscopy, while 45346 is performed with flexible sigmoidoscopy.
- 45300ProctosigmoidoscopyRigid, diagnostic
- 45300 is diagnostic rigid proctosigmoidoscopy. Choose 45320 when the service includes therapeutic lesion ablation.
45320 billing questions
How does 45320 differ from 45308 or 45309?
45320 is for ablation of a lesion not suitable for conventional removal. Codes 45308 and 45309 describe lesion removal using hot biopsy forceps or bipolar cautery, and snare technique, respectively.
How does this code differ from 45346?
Both describe lesion ablation, but 45320 is for rigid proctosigmoidoscopy. Code 45346 describes ablation during flexible sigmoidoscopy.
What should the procedure note document?
Document the lesion's location and the ablative treatment performed, including why the service was ablation rather than conventional forceps or snare removal.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are same-day care and surgical assistance paid separately?
The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay for an assistant at surgery, and does not permit co-surgeons or team surgery.
What happens when related endoscopies are performed together?
CMS applies endoscopy family pricing when related endoscopies are performed together, rather than pricing each related scope as an entirely independent procedure.
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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