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CPT code 45320: Proctosigmoidoscopy, lesion ablation2026 Medicare rate & RVUs in King County, WA

Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal.

CMS RVU26DEffective Oct 1, 2026One payment locality11 Medicare services in 2024

In King County, WA, Medicare pays $286.05 for 45320 in the office and $106.54 when it’s performed in a hospital or facility.

$286.05Office (non-facility)
$106.54Hospital or facility
+16.4%vs the national office rate ($245.83)

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.

We’ll open 45320 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in King County, WA
  2. What 45320 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 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 King County, WA 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. King County, WA pays $286.05. The RVUs are the same everywhere; the geographic indexes change the dollars.

45320 in King County, WA vs other payment areas
  1. King County, WA · this page$286.05
  2. Rest of Washington · Washington$252.47−$33.58
  3. Los Angeles, CA · California$275.59−$10.46
  4. Washington, DC area · District of Columbia$281.86−$4.19
  5. Miami, FL · Florida$275.04−$11.01
  6. Chicago, IL · Illinois$265.70−$20.35
  7. Manhattan, NY · New York$286.38+$0.33

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

Every other payment area

45320 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$278.26$122.45
AlabamaAlabama$217.51$89.50
ArkansasArkansas$213.95$88.28
ArizonaArizona$238.29$96.52
Bakersfield, CACalifornia$258.22$97.88
Chico, CACalifornia$257.06$96.72
El Centro, CACalifornia$257.13$96.79
Fresno, CACalifornia$257.06$96.72

45320 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.

$213.95

$290.18

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

View every state and territory as a table
45320 office rate range by state
State / territoryOffice rate rangeLocalities
AK$278.261
AL$217.511
AR$213.951
AZ$238.291
CA$257.06–$323.2929
CO$254.651
CT$263.551
DC$281.861
DE$242.531
FL$245.28–$275.043
GA$229.51–$251.712
GU$263.991
HI$263.991
IA$222.151
ID$224.131
IL$238.54–$265.704
IN$225.551
KS$221.741
KY$225.001
LA$224.91–$237.362
MA$253.16–$280.772
MD$247.32–$281.863
ME$226.27–$238.942
MI$232.31–$249.502
MN$240.841
MO$221.07–$237.383
MS$217.521
MT$245.801
NC$228.811
ND$237.301
NE$223.291
NH$251.281
NJ$265.67–$278.532
NM$234.051
NV$243.611
NY$232.73–$295.045
OH$230.571
OK$223.721
OR$240.86–$262.642
PA$230.55–$256.832
PR$247.561
RI$251.151
SC$230.251
SD$236.291
TN$223.101
TX$228.91–$254.558
UT$233.761
VA$238.60–$281.862
VI$247.561
VT$236.971
WA$252.47–$286.052
WI$228.471
WV$228.871
WY$242.101

See 45320 in every payment locality

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

Office or facility?

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 King County, WA 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

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 45320 in King County, WA
ComponentRVULocality factorAdjusted
Physician work1.64× 1.0501.7220
Practice expense5.29× 1.2276.4908
Malpractice0.43× 0.8170.3513
Total RVUs8.5641
Conversion factor× 33.4009

Office rate, King County, WA$286.05

Office: (1.64 × 1.05 + 5.29 × 1.227 + 0.43 × 0.817) × $33.4009 = $286.05

Facility: (1.64 × 1.05 + 0.91 × 1.227 + 0.43 × 0.817) × $33.4009 = $106.54

Open 45320 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 45320

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

Codes related to 45320
CodeHow it relatesOffice range, King County, WA
Same family
45308Lesion removal, rigid scope, cautery techniqueRigid proctosigmoidoscopic lesion removal using hot biopsy forceps or bipolar cautery.$266.38
45309Proctosigmoidoscopy, snare lesion removalRigid proctosigmoidoscopic lesion removal using a snare.$274.12
Used instead
45346Flexible sigmoidoscopy, lesion ablationAblation during flexible sigmoidoscopy rather than rigid proctosigmoidoscopy.$3,037.29
45305Proctosigmoidoscopy, rigid scope with biopsyRigid proctosigmoidoscopy with biopsy when tissue sampling, rather than ablation, is performed.$234.08

How 45320 has changed in King County, WA

45320 · Office / nonfacility

$286.05

Effective 2026-10-01

The base rate is $40.04 higher than on 2025-10-01, moving from $246.01 to $286.05 (16.3%).

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

    $246.01changed to$286.05

    • 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 1.043 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

    $256.25changed to$246.01

    • 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.

  3. March 9, 2024

    RVU24AR

    $252.07changed to$256.25

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $261.35changed to$252.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.66 changed to 4.58
    • 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

    $269.02changed to$261.35

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.78 changed to 4.66
    • 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

    $266.25changed to$269.02

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.66 changed to 4.78

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $230.96changed to$266.25

    • 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 1.031 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

    $215.53changed to$230.96

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.38 changed to 3.69
    • 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

    $201.76changed to$215.53

    • 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.

  10. January 1, 2018

    RVU18AR1

    $194.94changed to$201.76

    • 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 1.026 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

    $268.79changed to$194.94

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.78 changed to 1.68
    • Practice expense RVU 4.74 changed to 2.98
    • Malpractice RVU 0.42 changed to 0.39
    • 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

    $272.42changed to$268.79

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.80 changed to 4.74
    • Malpractice RVU 0.43 changed to 0.42

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $271.07changed to$272.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $269.26changed to$271.07

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.77 changed to 4.80
    • Malpractice RVU 0.30 changed to 0.43
    • 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

    $282.33changed to$269.26

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.42 changed to 4.77
    • Malpractice RVU 0.31 changed to 0.30
    • 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: $282.33

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$286.05$106.54RVU26D
2026-07-01$286.05$106.54RVU26C
2026-04-01$286.05$106.54RVU26B
2026-01-01$286.05$106.54RVU26A
2025-10-01$246.01$111.04RVU25D
2025-07-01$246.01$111.04RVU25C
2025-04-01$246.01$111.04RVU25B
2025-01-01$246.01$111.04RVU25A
2024-10-01$256.25$112.49RVU24D
2024-07-01$256.25$112.49RVU24C
2024-04-01$256.25$112.49RVU24B
2024-03-09$256.25$112.49RVU24AR
2024-01-01$252.07$110.65RVU24A
2023-10-01$261.35$112.06RVU23D
2023-07-01$261.35$112.06RVU23C
2023-04-01$261.35$112.06RVU23B
2023-01-01$261.35$112.06RVU23A
2022-10-01$269.02$113.24RVU22D
2022-07-01$269.02$113.24RVU22C
2022-04-01$269.02$113.24RVU22B
2022-01-01$269.02$113.24RVU22A
2021-10-01$266.25$113.35RVU21D
2021-07-01$266.25$113.35RVU21C
2021-04-01$266.25$113.35RVU21B
2021-01-01$266.25$113.35RVU21A
2020-10-01$230.96$115.68RVU20D
2020-07-01$230.96$115.68RVU20C
2020-04-01$230.96$115.68RVU20B
2020-01-01$230.96$115.68RVU20A
2019-10-01$215.53$115.17RVU19D
2019-07-01$215.53$115.17RVU19C
2019-04-01$215.53$115.17RVU19B
2019-01-01$215.53$115.17RVU19A
2018-10-01$201.76$115.12RVU18D
2018-07-01$201.76$115.12RVU18C
2018-04-01$201.76$115.12RVU18B
2018-01-01$201.76$115.12RVU18AR1
2017-10-01$194.94$111.50RVU17D
2017-07-01$194.94$111.50RVU17C
2017-04-01$194.94$111.50RVU17B
2017-01-01$194.94$111.50RVU17A
2016-10-01$268.79$114.12RVU16D
2016-07-01$268.79$114.12RVU16C
2016-04-01$268.79$114.12RVU16B
2016-01-01$268.79$114.12RVU16A
2015-10-01$272.42$114.71RVU15D
2015-07-01$272.42$114.71RVU15C
2015-04-01$271.07$114.14RVU15B
2015-01-01$271.07$114.14RVU15A
2014-10-01$269.26$113.95RVU14D
2014-07-01$269.26$113.95RVU14C
2014-04-01$269.26$113.95RVU14B
2014-01-01$269.26$113.95RVU14A
2013-10-01$282.33$114.57RVU13D
2013-07-01$282.33$114.57RVU13C
2013-04-01$282.33$114.57RVU13B
2013-01-01$282.33$114.57RVU13AR

Price 45320 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
  • 45320 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

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
RVUs for 45320PPRRVU2026_Oct_nonQPP.csv, line 5,495 (RVU26D)
Geographic factors for King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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