CPT code 45320: Proctosigmoidoscopy, lesion ablation2026 Medicare rate & RVUs in Merced, CA
Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal.
In Merced, CA, Medicare pays $257.06 for 45320 in the office and $96.72 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45320 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 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.
How Merced, CA compares for 45320
Across 109 of 109 payment localities, the office rate for 45320 runs from $213.95 in Arkansas to $323.29 in San Benito County, CA. Merced, CA pays $257.06. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Merced, CA · this page$257.06
- Bakersfield, CA · California$258.22+$1.16
- Chico, CA · California$257.06
- El Centro, CA · California$257.13+$0.07
- Fresno, CA · California$257.06
- Hanford, CA · California$257.06
- Los Angeles, CA · California$275.59+$18.53
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $257.06 | $96.72 |
| Modesto, CACalifornia | $257.06 | $96.72 |
| Napa, CACalifornia | $298.40 | $105.58 |
| Oxnard, CACalifornia | $274.11 | $101.19 |
| Redding, CACalifornia | $257.06 | $96.72 |
| Rest of CaliforniaCalifornia | $257.06 | $96.72 |
| Riverside, CACalifornia | $261.67 | $101.33 |
| Sacramento, CACalifornia | $269.94 | $99.80 |
| Salinas, CACalifornia | $268.96 | $99.40 |
| San Diego, CACalifornia | $275.53 | $100.56 |
| Marin County, CACalifornia | $315.71 | $109.43 |
| San Francisco, CACalifornia | $315.22 | $108.94 |
| San Benito County, CACalifornia | $323.29 | $112.33 |
| Santa Clara County, CACalifornia | $321.29 | $110.33 |
| San Luis Obispo, CACalifornia | $264.66 | $98.03 |
| Santa Cruz, CACalifornia | $278.31 | $100.56 |
| Santa Maria, CACalifornia | $270.03 | $99.45 |
| Santa Rosa, CACalifornia | $281.10 | $101.44 |
| Stockton, CACalifornia | $257.06 | $96.72 |
| Vallejo, CACalifornia | $297.70 | $104.88 |
| Visalia, CACalifornia | $257.06 | $96.72 |
| Yuba City, CACalifornia | $257.06 | $96.72 |
| Washington, DC areaDistrict of Columbia | $281.86 | $109.53 |
| Miami, FLFlorida | $275.04 | $122.74 |
| Chicago, ILIllinois | $265.70 | $118.67 |
| Manhattan, NYNew York | $286.38 | $116.38 |
| AlaskaAlaska | $278.26 | $122.45 |
| AlabamaAlabama | $217.51 | $89.50 |
| ArkansasArkansas | $213.95 | $88.28 |
| ArizonaArizona | $238.29 | $96.52 |
| ColoradoColorado | $254.65 | $98.99 |
| ConnecticutConnecticut | $263.55 | $105.99 |
| DelawareDelaware | $242.53 | $97.99 |
| Fort Lauderdale, FLFlorida | $259.73 | $111.53 |
| Rest of FloridaFlorida | $245.28 | $105.42 |
| Atlanta, GAGeorgia | $251.71 | $103.07 |
| Rest of GeorgiaGeorgia | $229.51 | $99.01 |
| Hawaii, Guam, HIHawaii | $263.99 | $97.65 |
| IowaIowa | $222.15 | $88.29 |
| IdahoIdaho | $224.13 | $89.53 |
| East St. Louis, ILIllinois | $246.26 | $111.67 |
| Rest of IllinoisIllinois | $238.54 | $104.98 |
| Suburban Chicago, ILIllinois | $262.07 | $111.83 |
| IndianaIndiana | $225.55 | $89.93 |
| KansasKansas | $221.74 | $89.49 |
| KentuckyKentucky | $225.00 | $94.94 |
| New Orleans, LALouisiana | $237.36 | $99.69 |
| Rest of LouisianaLouisiana | $224.91 | $95.44 |
| Metropolitan Boston, MAMassachusetts | $280.77 | $106.10 |
| Rest of MassachusettsMassachusetts | $253.16 | $99.11 |
| Baltimore area, MDMaryland | $263.01 | $106.03 |
| Rest of MarylandMaryland | $247.32 | $99.27 |
| Rest of MaineMaine | $226.27 | $91.67 |
| Southern Maine, MEMaine | $238.94 | $93.96 |
| Detroit, MIMichigan | $249.50 | $108.32 |
| Rest of MichiganMichigan | $232.31 | $98.74 |
| MinnesotaMinnesota | $240.84 | $90.31 |
| Metropolitan Kansas City, MOMissouri | $234.72 | $97.35 |
| Metropolitan St. Louis, MOMissouri | $237.38 | $98.10 |
| Rest of MissouriMissouri | $221.07 | $94.97 |
| MississippiMississippi | $217.52 | $91.56 |
| MontanaMontana | $245.80 | $99.51 |
| North CarolinaNorth Carolina | $228.81 | $92.31 |
| North DakotaNorth Dakota | $237.30 | $91.00 |
| NebraskaNebraska | $223.29 | $88.26 |
| New HampshireNew Hampshire | $251.28 | $98.99 |
| Northern New JerseyNew Jersey | $278.53 | $108.83 |
| Rest of New JerseyNew Jersey | $265.67 | $105.92 |
| New MexicoNew Mexico | $234.05 | $99.90 |
| NevadaNevada | $243.61 | $97.17 |
| NYC suburbs and Long Island, NYNew York | $295.04 | $121.09 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $268.10 | $107.90 |
| Queens, NYNew York | $287.84 | $114.92 |
| Rest of New YorkNew York | $232.73 | $93.75 |
| OhioOhio | $230.57 | $97.01 |
| OklahomaOklahoma | $223.72 | $93.08 |
| Portland, OROregon | $262.64 | $100.11 |
| Rest of OregonOregon | $240.86 | $95.15 |
| Metropolitan Philadelphia, PAPennsylvania | $256.83 | $104.54 |
| Rest of PennsylvaniaPennsylvania | $230.55 | $96.25 |
| Puerto RicoPuerto Rico | $247.56 | $99.65 |
| Rhode IslandRhode Island | $251.15 | $100.03 |
| South CarolinaSouth Carolina | $230.25 | $95.07 |
| South DakotaSouth Dakota | $236.29 | $90.00 |
| TennesseeTennessee | $223.10 | $90.12 |
| Austin, TXTexas | $254.55 | $99.77 |
| Beaumont, TXTexas | $228.91 | $95.78 |
| Brazoria, TXTexas | $241.52 | $96.54 |
| Dallas, TXTexas | $243.58 | $97.87 |
| Fort Worth, TXTexas | $242.00 | $97.75 |
| Galveston, TXTexas | $242.56 | $97.29 |
| Houston, TXTexas | $250.43 | $105.16 |
| Rest of TexasTexas | $235.43 | $96.59 |
| UtahUtah | $233.76 | $96.25 |
| VirginiaVirginia | $238.60 | $94.80 |
| Virgin Islands, VIUnited States Virgin Islands | $247.56 | $99.65 |
| VermontVermont | $236.97 | $92.14 |
| Rest of WashingtonWashington | $252.47 | $98.43 |
| King County, WAWashington | $286.05 | $106.54 |
| WisconsinWisconsin | $228.47 | $88.32 |
| West VirginiaWest Virginia | $228.87 | $101.74 |
| WyomingWyoming | $242.10 | $95.80 |
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.
The exact Merced, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,495
- Code
- 45320
- Physician work
- 1.64
- Practice expense
- 5.29
- Malpractice
- 0.43
GPCI2026.csv
15
- Locality
- Merced, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.64 | × 1.017 | 1.6679 |
| Practice expense | 5.29 | × 1.096 | 5.7978 |
| Malpractice | 0.43 | × 0.536 | 0.2305 |
| Total RVUs | 7.6962 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Merced, CA$257.06
Office: (1.64 × 1.017 + 5.29 × 1.096 + 0.43 × 0.536) × $33.4009 = $257.06
Facility: (1.64 × 1.017 + 0.91 × 1.096 + 0.43 × 0.536) × $33.4009 = $96.72
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%).
How 45320 has changed in Merced, CA
45320 · Office / nonfacility
$257.06
Effective 2026-10-01
The base rate is $35.24 higher than on 2025-10-01, moving from $221.82 to $257.06 (15.9%).
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
$221.82changed to$257.06
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.68 changed to 1.64
- Practice expense RVU 4.49 changed to 5.29
- Malpractice RVU 0.44 changed to 0.43
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$231.17changed to$221.82
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.58 changed to 4.49
- Malpractice RVU 0.42 changed to 0.44
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$227.40changed to$231.17
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$236.76changed to$227.40
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.66 changed to 4.58
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$244.56changed to$236.76
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.78 changed to 4.66
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$242.12changed to$244.56
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.66 changed to 4.78
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$213.16changed to$242.12
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.69 changed to 4.66
- Malpractice RVU 0.41 changed to 0.42
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$200.89changed to$213.16
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.38 changed to 3.69
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$188.09changed to$200.89
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.06 changed to 3.38
- Malpractice RVU 0.40 changed to 0.41
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$185.68changed to$188.09
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.98 changed to 3.06
- Malpractice RVU 0.39 changed to 0.40
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$185.68
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 | $257.06 | $96.72 | RVU26D |
| 2026-07-01 | $257.06 | $96.72 | RVU26C |
| 2026-04-01 | $257.06 | $96.72 | RVU26B |
| 2026-01-01 | $257.06 | $96.72 | RVU26A |
| 2025-10-01 | $221.82 | $100.90 | RVU25D |
| 2025-07-01 | $221.82 | $100.90 | RVU25C |
| 2025-04-01 | $221.82 | $100.90 | RVU25B |
| 2025-01-01 | $221.82 | $100.90 | RVU25A |
| 2024-10-01 | $231.17 | $102.37 | RVU24D |
| 2024-07-01 | $231.17 | $102.37 | RVU24C |
| 2024-04-01 | $231.17 | $102.37 | RVU24B |
| 2024-03-09 | $231.17 | $102.37 | RVU24AR |
| 2024-01-01 | $227.40 | $100.70 | RVU24A |
| 2023-10-01 | $236.76 | $103.30 | RVU23D |
| 2023-07-01 | $236.76 | $103.30 | RVU23C |
| 2023-04-01 | $236.76 | $103.30 | RVU23B |
| 2023-01-01 | $236.76 | $103.30 | RVU23A |
| 2022-10-01 | $244.56 | $105.61 | RVU22D |
| 2022-07-01 | $244.56 | $105.61 | RVU22C |
| 2022-04-01 | $244.56 | $105.61 | RVU22B |
| 2022-01-01 | $244.56 | $105.61 | RVU22A |
| 2021-10-01 | $242.12 | $105.74 | RVU21D |
| 2021-07-01 | $242.12 | $105.74 | RVU21C |
| 2021-04-01 | $242.12 | $105.74 | RVU21B |
| 2021-01-01 | $242.12 | $105.74 | RVU21A |
| 2020-10-01 | $213.16 | $107.74 | RVU20D |
| 2020-07-01 | $213.16 | $107.74 | RVU20C |
| 2020-04-01 | $213.16 | $107.74 | RVU20B |
| 2020-01-01 | $213.16 | $107.74 | RVU20A |
| 2019-10-01 | $200.89 | $106.83 | RVU19D |
| 2019-07-01 | $200.89 | $106.83 | RVU19C |
| 2019-04-01 | $200.89 | $106.83 | RVU19B |
| 2019-01-01 | $200.89 | $106.83 | RVU19A |
| 2018-10-01 | $188.09 | $106.90 | RVU18D |
| 2018-07-01 | $188.09 | $106.90 | RVU18C |
| 2018-04-01 | $188.09 | $106.90 | RVU18B |
| 2018-01-01 | $188.09 | $106.90 | RVU18AR1 |
| 2017-10-01 | $185.68 | $107.45 | RVU17D |
| 2017-07-01 | $185.68 | $107.45 | RVU17C |
| 2017-04-01 | $185.68 | $107.45 | RVU17B |
| 2017-01-01 | $185.68 | $107.45 | 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 Merced, CA rate applies
Merced, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Merced
- Atwater
- Ballico
- Bear Creek
- Cressey
- Delhi
- Dos Palos
- Dos Palos Y
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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