CPT code 45331: Sigmoidoscopy, with biopsy2026 Medicare rate & RVUs in North Dakota
Reports flexible sigmoidoscopy with one or more tissue biopsies when a clinician samples the rectum or distal colon for diagnosis.
In North Dakota, Medicare pays $320.21 for 45331 in the office and $64.02 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45331 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 45331 covers
A clinician advances a flexible endoscope through the anus to examine the rectum and distal colon, then collects mucosal tissue for analysis. Gastroenterologists and colorectal surgeons commonly perform this service in an endoscopy unit, hospital outpatient department, or office. Typical reasons include evaluating suspected colitis, unexplained rectal bleeding, or an abnormality seen on prior testing. The biopsy may involve one or multiple tissue samples during the same examination.
Report this code when the procedure includes tissue biopsy, rather than inspection alone; the number of samples does not determine separate units. The record should identify the sampled site and clinical reason, and support that tissue was obtained. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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 North Dakota compares for 45331
Across 109 of 109 payment localities, the office rate for 45331 runs from $281.06 in Arkansas to $449.20 in San Benito County, CA. North Dakota pays $320.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$320.21
- Los Angeles, CA · California$374.40+$54.19
- Washington, DC area · District of Columbia$375.58+$55.37
- Miami, FL · Florida$341.67+$21.46
- Chicago, IL · Illinois$330.71+$10.50
- Manhattan, NY · New York$373.66+$53.45
- Alaska · Alaska$357.70+$37.49
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $285.80 | $61.64 |
| ArkansasArkansas | $281.06 | $61.00 |
| ArizonaArizona | $313.60 | $65.35 |
| Bakersfield, CACalifornia | $348.86 | $68.08 |
| Chico, CACalifornia | $348.45 | $67.67 |
| El Centro, CACalifornia | $348.47 | $67.69 |
| Fresno, CACalifornia | $348.45 | $67.67 |
| Hanford, CACalifornia | $348.45 | $67.67 |
| Madera, CACalifornia | $348.45 | $67.67 |
| Merced, CACalifornia | $348.45 | $67.67 |
| Modesto, CACalifornia | $348.45 | $67.67 |
| Napa, CACalifornia | $412.45 | $74.80 |
| Oxnard, CACalifornia | $373.45 | $70.64 |
| Redding, CACalifornia | $348.45 | $67.67 |
| Rest of CaliforniaCalifornia | $348.45 | $67.67 |
| Riverside, CACalifornia | $349.97 | $69.19 |
| Sacramento, CACalifornia | $367.99 | $70.05 |
| Salinas, CACalifornia | $366.68 | $69.76 |
| San Diego, CACalifornia | $377.08 | $70.68 |
| Marin County, CACalifornia | $439.29 | $78.06 |
| San Francisco, CACalifornia | $439.13 | $77.91 |
| San Benito County, CACalifornia | $449.20 | $79.78 |
| Santa Clara County, CACalifornia | $448.55 | $79.13 |
| San Luis Obispo, CACalifornia | $360.54 | $68.74 |
| Santa Cruz, CACalifornia | $382.06 | $70.80 |
| Santa Maria, CACalifornia | $368.54 | $69.83 |
| Santa Rosa, CACalifornia | $386.05 | $71.46 |
| Stockton, CACalifornia | $348.45 | $67.67 |
| Vallejo, CACalifornia | $412.23 | $74.57 |
| Visalia, CACalifornia | $348.45 | $67.67 |
| Yuba City, CACalifornia | $348.45 | $67.67 |
| ColoradoColorado | $340.41 | $67.83 |
| ConnecticutConnecticut | $346.37 | $70.45 |
| DelawareDelaware | $319.32 | $66.21 |
| Fort Lauderdale, FLFlorida | $330.42 | $70.91 |
| Rest of FloridaFlorida | $312.96 | $68.05 |
| Atlanta, GAGeorgia | $328.54 | $68.25 |
| Rest of GeorgiaGeorgia | $293.51 | $64.99 |
| Hawaii, Guam, HIHawaii | $359.55 | $68.27 |
| IowaIowa | $296.26 | $61.85 |
| IdahoIdaho | $298.02 | $62.33 |
| East St. Louis, ILIllinois | $305.23 | $69.54 |
| Rest of IllinoisIllinois | $301.15 | $67.26 |
| Suburban Chicago, ILIllinois | $334.45 | $71.35 |
| IndianaIndiana | $300.05 | $62.57 |
| KansasKansas | $293.67 | $62.08 |
| KentuckyKentucky | $291.37 | $63.62 |
| New Orleans, LALouisiana | $307.03 | $65.96 |
| Rest of LouisianaLouisiana | $290.45 | $63.72 |
| Metropolitan Boston, MAMassachusetts | $378.55 | $72.67 |
| Rest of MassachusettsMassachusetts | $337.54 | $67.77 |
| Baltimore area, MDMaryland | $345.22 | $70.33 |
| Rest of MarylandMaryland | $326.35 | $67.09 |
| Rest of MaineMaine | $298.72 | $63.03 |
| Southern Maine, MEMaine | $318.73 | $64.85 |
| Detroit, MIMichigan | $316.35 | $69.13 |
| Rest of MichiganMichigan | $299.12 | $65.23 |
| MinnesotaMinnesota | $327.85 | $64.24 |
| Metropolitan Kansas City, MOMissouri | $305.72 | $65.17 |
| Metropolitan St. Louis, MOMissouri | $309.50 | $65.61 |
| Rest of MissouriMissouri | $284.05 | $63.22 |
| MississippiMississippi | $282.67 | $62.10 |
| MontanaMontana | $322.98 | $66.79 |
| North CarolinaNorth Carolina | $302.46 | $63.44 |
| NebraskaNebraska | $298.42 | $61.96 |
| New HampshireNew Hampshire | $333.93 | $67.24 |
| Northern New JerseyNew Jersey | $370.64 | $73.46 |
| Rest of New JerseyNew Jersey | $350.80 | $71.04 |
| New MexicoNew Mexico | $300.58 | $65.66 |
| NevadaNevada | $322.49 | $66.05 |
| NYC suburbs and Long Island, NYNew York | $382.52 | $77.92 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $352.35 | $71.83 |
| Queens, NYNew York | $378.61 | $75.80 |
| Rest of New YorkNew York | $307.54 | $64.16 |
| OhioOhio | $298.56 | $64.66 |
| OklahomaOklahoma | $291.85 | $63.08 |
| Portland, OROregon | $353.60 | $68.98 |
| Rest of OregonOregon | $320.47 | $65.31 |
| Metropolitan Philadelphia, PAPennsylvania | $336.09 | $69.40 |
| Rest of PennsylvaniaPennsylvania | $299.67 | $64.49 |
| Puerto RicoPuerto Rico | $326.01 | $67.01 |
| Rhode IslandRhode Island | $332.47 | $67.83 |
| South CarolinaSouth Carolina | $300.91 | $64.20 |
| South DakotaSouth Dakota | $319.88 | $63.70 |
| TennesseeTennessee | $295.23 | $62.36 |
| Austin, TXTexas | $338.84 | $67.80 |
| Beaumont, TXTexas | $297.34 | $64.22 |
| Brazoria, TXTexas | $319.72 | $65.84 |
| Dallas, TXTexas | $321.53 | $66.37 |
| Fort Worth, TXTexas | $318.78 | $66.18 |
| Galveston, TXTexas | $320.51 | $66.12 |
| Houston, TXTexas | $323.07 | $68.68 |
| Rest of TexasTexas | $308.19 | $65.07 |
| UtahUtah | $305.64 | $64.82 |
| VirginiaVirginia | $316.83 | $65.00 |
| Virgin Islands, VIUnited States Virgin Islands | $326.01 | $67.01 |
| VermontVermont | $317.86 | $64.24 |
| Rest of WashingtonWashington | $337.26 | $67.49 |
| King County, WAWashington | $387.83 | $73.49 |
| WisconsinWisconsin | $307.94 | $62.51 |
| West VirginiaWest Virginia | $288.16 | $65.54 |
| WyomingWyoming | $321.77 | $65.59 |
45331 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.
$281.06
$398.83
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 | $357.70 | 1 |
| AL | $285.80 | 1 |
| AR | $281.06 | 1 |
| AZ | $313.60 | 1 |
| CA | $348.45–$449.20 | 29 |
| CO | $340.41 | 1 |
| CT | $346.37 | 1 |
| DC | $375.58 | 1 |
| DE | $319.32 | 1 |
| FL | $312.96–$341.67 | 3 |
| GA | $293.51–$328.54 | 2 |
| GU | $359.55 | 1 |
| HI | $359.55 | 1 |
| IA | $296.26 | 1 |
| ID | $298.02 | 1 |
| IL | $301.15–$334.45 | 4 |
| IN | $300.05 | 1 |
| KS | $293.67 | 1 |
| KY | $291.37 | 1 |
| LA | $290.45–$307.03 | 2 |
| MA | $337.54–$378.55 | 2 |
| MD | $326.35–$375.58 | 3 |
| ME | $298.72–$318.73 | 2 |
| MI | $299.12–$316.35 | 2 |
| MN | $327.85 | 1 |
| MO | $284.05–$309.50 | 3 |
| MS | $282.67 | 1 |
| MT | $322.98 | 1 |
| NC | $302.46 | 1 |
| ND | $320.21 | 1 |
| NE | $298.42 | 1 |
| NH | $333.93 | 1 |
| NJ | $350.80–$370.64 | 2 |
| NM | $300.58 | 1 |
| NV | $322.49 | 1 |
| NY | $307.54–$382.52 | 5 |
| OH | $298.56 | 1 |
| OK | $291.85 | 1 |
| OR | $320.47–$353.60 | 2 |
| PA | $299.67–$336.09 | 2 |
| PR | $326.01 | 1 |
| RI | $332.47 | 1 |
| SC | $300.91 | 1 |
| SD | $319.88 | 1 |
| TN | $295.23 | 1 |
| TX | $297.34–$338.84 | 8 |
| UT | $305.64 | 1 |
| VA | $316.83–$375.58 | 2 |
| VI | $326.01 | 1 |
| VT | $317.86 | 1 |
| WA | $337.26–$387.83 | 2 |
| WI | $307.94 | 1 |
| WV | $288.16 | 1 |
| WY | $321.77 | 1 |
How the 45331 rate is calculated
Each of 45331’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 · 45331
RVUs × geographic indexes × conversion factor
Work1.11
1.11 RVUs× 1.000 GPCI
Practice expense8.42
8.42 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
9.6700
Conversion factor
$33.4009
Medicare rate
$322.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,499
- Code
- 45331
- Physician work
- 1.11
- Practice expense
- 8.42
- Malpractice
- 0.14
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.11 | × 1.000 | 1.1100 |
| Practice expense | 8.42 | × 1.000 | 8.4200 |
| Malpractice | 0.14 | × 0.406 | 0.0568 |
| Total RVUs | 9.5868 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$320.21
Office: (1.11 × 1 + 8.42 × 1 + 0.14 × 0.406) × $33.4009 = $320.21
Facility: (1.11 × 1 + 0.75 × 1 + 0.14 × 0.406) × $33.4009 = $64.02
Payment rules and modifiers for 45331
The CMS indicators that decide how 45331 is paid alongside other services.
CMS payment indicators · 45331
Sigmoidoscopy, with biopsy
| 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
45331 without 51 · national office
$322.99
Sigmoidoscopy, with biopsy
45331-51 · Second procedure: 50%
$161.50
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 45331 has changed in North Dakota
45331 · Office / nonfacility
$320.21
Effective 2026-10-01
The base rate is $50.68 higher than on 2025-10-01, moving from $269.53 to $320.21 (18.8%).
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
$269.53changed to$320.21
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.14 changed to 1.11
- Practice expense RVU 7.11 changed to 8.42
- Malpractice RVU 0.16 changed to 0.14
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$283.20changed to$269.53
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 7.29 changed to 7.11
- Malpractice RVU 0.15 changed to 0.16
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$278.57changed to$283.20
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$289.95changed to$278.57
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 7.35 changed to 7.29
- Malpractice RVU 0.14 changed to 0.15
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$303.56changed to$289.95
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.58 changed to 7.35
- Malpractice RVU 0.12 changed to 0.14
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$303.58changed to$303.56
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 7.50 changed to 7.58
- Malpractice RVU 0.14 changed to 0.12
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$280.17changed to$303.58
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 6.56 changed to 7.50
- Malpractice RVU 0.13 changed to 0.14
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$271.41changed to$280.17
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 6.31 changed to 6.56
- Malpractice RVU 0.15 changed to 0.13
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$262.47changed to$271.41
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.07 changed to 6.31
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$258.47changed to$262.47
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 5.98 changed to 6.07
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$257.90changed to$258.47
- Conversion factor 35.8043 changed to 35.8887
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$164.01changed to$257.90
- Conversion factor 35.9335 changed to 35.8043
- Work RVU 1.15 changed to 1.14
- Practice expense RVU 3.32 changed to 5.98
- Malpractice RVU 0.17 changed to 0.15
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$163.19changed to$164.01
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$162.68changed to$163.19
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.30 changed to 3.32
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$171.92changed to$162.68
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.81 changed to 3.30
- Malpractice RVU 0.18 changed to 0.17
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $171.92
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $320.21 | $64.02 | RVU26D |
| 2026-07-01 | $320.21 | $64.02 | RVU26C |
| 2026-04-01 | $320.21 | $64.02 | RVU26B |
| 2026-01-01 | $320.21 | $64.02 | RVU26A |
| 2025-10-01 | $269.53 | $67.69 | RVU25D |
| 2025-07-01 | $269.53 | $67.69 | RVU25C |
| 2025-04-01 | $269.53 | $67.69 | RVU25B |
| 2025-01-01 | $269.53 | $67.69 | RVU25A |
| 2024-10-01 | $283.20 | $69.16 | RVU24D |
| 2024-07-01 | $283.20 | $69.16 | RVU24C |
| 2024-04-01 | $283.20 | $69.16 | RVU24B |
| 2024-03-09 | $283.20 | $69.16 | RVU24AR |
| 2024-01-01 | $278.57 | $68.03 | RVU24A |
| 2023-10-01 | $289.95 | $69.35 | RVU23D |
| 2023-07-01 | $289.95 | $69.35 | RVU23C |
| 2023-04-01 | $289.95 | $69.35 | RVU23B |
| 2023-01-01 | $289.95 | $69.35 | RVU23A |
| 2022-10-01 | $303.56 | $69.96 | RVU22D |
| 2022-07-01 | $303.56 | $69.96 | RVU22C |
| 2022-04-01 | $303.56 | $69.96 | RVU22B |
| 2022-01-01 | $303.56 | $69.96 | RVU22A |
| 2021-10-01 | $303.58 | $70.15 | RVU21D |
| 2021-07-01 | $303.58 | $70.15 | RVU21C |
| 2021-04-01 | $303.58 | $70.15 | RVU21B |
| 2021-01-01 | $303.58 | $70.15 | RVU21A |
| 2020-10-01 | $280.17 | $71.93 | RVU20D |
| 2020-07-01 | $280.17 | $71.93 | RVU20C |
| 2020-04-01 | $280.17 | $71.93 | RVU20B |
| 2020-01-01 | $280.17 | $71.93 | RVU20A |
| 2019-10-01 | $271.41 | $72.47 | RVU19D |
| 2019-07-01 | $271.41 | $72.47 | RVU19C |
| 2019-04-01 | $271.41 | $72.47 | RVU19B |
| 2019-01-01 | $271.41 | $72.47 | RVU19A |
| 2018-10-01 | $262.47 | $73.12 | RVU18D |
| 2018-07-01 | $262.47 | $73.12 | RVU18C |
| 2018-04-01 | $262.47 | $73.12 | RVU18B |
| 2018-01-01 | $262.47 | $73.12 | RVU18AR1 |
| 2017-10-01 | $258.47 | $73.29 | RVU17D |
| 2017-07-01 | $258.47 | $73.29 | RVU17C |
| 2017-04-01 | $258.47 | $73.29 | RVU17B |
| 2017-01-01 | $258.47 | $73.29 | RVU17A |
| 2016-10-01 | $257.90 | $72.79 | RVU16D |
| 2016-07-01 | $257.90 | $72.79 | RVU16C |
| 2016-04-01 | $257.90 | $72.79 | RVU16B |
| 2016-01-01 | $257.90 | $72.79 | RVU16A |
| 2015-10-01 | $164.01 | $74.89 | RVU15D |
| 2015-07-01 | $164.01 | $74.89 | RVU15C |
| 2015-04-01 | $163.19 | $74.52 | RVU15B |
| 2015-01-01 | $163.19 | $74.52 | RVU15A |
| 2014-10-01 | $162.68 | $74.55 | RVU14D |
| 2014-07-01 | $162.68 | $74.55 | RVU14C |
| 2014-04-01 | $162.68 | $74.55 | RVU14B |
| 2014-01-01 | $162.68 | $74.55 | RVU14A |
| 2013-10-01 | $171.92 | $74.95 | RVU13D |
| 2013-07-01 | $171.92 | $74.95 | RVU13C |
| 2013-04-01 | $171.92 | $74.95 | RVU13B |
| 2013-01-01 | $171.92 | $74.95 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
45331 billing questions
How does this differ from diagnostic sigmoidoscopy?
Use 45331 when the flexible examination includes tissue sampling. Use 45330 when the examination is diagnostic without biopsy or another reportable intervention.
Can multiple biopsy samples be reported as multiple units?
No. The code covers one or multiple biopsies during the sigmoidoscopy; the number of specimens alone does not create additional units.
Can the biopsy and a polypectomy be reported together?
A biopsy that is simply part of removing the same lesion should not be represented separately as a diagnostic biopsy. Distinct sampling or treatment requires documentation of what was done and where.
Should modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, and modifier 50 should not be used.
Is same-day care included in the payment?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.
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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