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CPT code 45333: Flexible sigmoidoscopy, hot biopsy forceps removal2026 Medicare rate & RVUs in Alabama

Reports flexible sigmoidoscopy with removal of a colorectal lesion using hot biopsy forceps, such as treatment of a polyp found in the examined segment.

CMS RVU26DEffective Oct 1, 2026One payment locality514 Medicare services in 2024

In Alabama, Medicare pays $326.10 for 45333 in the office and $79.73 when it’s performed in a hospital or facility.

$326.10Office (non-facility)
$79.73Hospital or facility
−11.4%vs the national office rate ($368.08)

Check a contract rate as a % of Medicare · 45333 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 45333 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Alabama
  2. What 45333 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 45333 covers

A flexible sigmoidoscope is advanced through the rectum to examine the lower colon. During the examination, the endoscopist uses hot biopsy forceps to grasp and remove a lesion, commonly a small polyp. Gastroenterologists and other physicians trained in gastrointestinal endoscopy perform this service in settings such as an endoscopy center or hospital outpatient department.

Select this code when the documented removal technique is hot biopsy forceps, rather than tissue sampling alone or removal by snare. The report should identify the examined segment, lesion, and removal method. When related endoscopies are performed in the same session, CMS applies endoscopy-family pricing rather than pricing each service independently. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is barred, 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 Alabama compares for 45333

Across 109 of 109 payment localities, the office rate for 45333 runs from $320.76 in Arkansas to $507.37 in San Benito County, CA. Alabama pays $326.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

45333 in Alabama vs other payment areas
  1. Alabama · this page$326.10
  2. Los Angeles, CA · California$424.46+$98.36
  3. Washington, DC area · District of Columbia$426.86+$100.76
  4. Miami, FL · Florida$392.04+$65.94
  5. Chicago, IL · Illinois$379.50+$53.40
  6. Manhattan, NY · New York$425.88+$99.78
  7. Alaska · Alaska$410.17+$84.07

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

Every other payment area

45333 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$320.76$78.89
ArizonaArizona$357.40$84.56
Bakersfield, CACalifornia$395.95$87.35
Chico, CACalifornia$395.31$86.71
El Centro, CACalifornia$395.35$86.75
Fresno, CACalifornia$395.31$86.71
Hanford, CACalifornia$395.31$86.71
Madera, CACalifornia$395.31$86.71

45333 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.

$320.76

$451.34

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

View every state and territory as a table
45333 office rate range by state
State / territoryOffice rate rangeLocalities
AK$410.171
AL$326.101
AR$320.761
AZ$357.401
CA$395.31–$507.3729
CO$386.931
CT$394.521
DC$426.861
DE$363.861
FL$358.12–$392.043
GA$335.98–$374.672
GU$407.491
HI$407.491
IA$337.271
ID$339.381
IL$345.22–$382.484
IN$341.651
KS$334.641
KY$333.011
LA$332.09–$350.772
MA$383.84–$429.532
MD$371.70–$426.863
ME$340.48–$362.572
MI$342.03–$362.262
MN$371.901
MO$325.07–$353.203
MS$323.031
MT$368.061
NC$344.641
ND$363.711
NE$339.611
NH$379.881
NJ$399.36–$421.402
NM$343.801
NV$367.161
NY$350.38–$436.255
OH$341.141
OK$333.241
OR$364.65–$401.452
PA$342.23–$383.132
PR$371.381
RI$378.481
SC$343.391
SD$363.201
TN$336.441
TX$339.63–$385.348
UT$348.711
VA$360.64–$426.862
VI$371.381
VT$361.341
WA$383.42–$439.692
WI$349.961
WV$330.601
WY$366.171

See 45333 in every payment locality

How the 45333 rate is calculated

Each of 45333’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 · 45333

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.51

1.51 RVUs× 1.000 GPCI

Practice expense9.29

9.29 RVUs× 1.000 GPCI

Malpractice0.22

0.22 RVUs× 1.000 GPCI

Adjusted RVUs

11.0200

Conversion factor

$33.4009

Medicare rate

$368.08

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Alabama inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,501

Code
45333
Physician work
1.51
Practice expense
9.29
Malpractice
0.22

GPCI2026.csv

4

Locality
Alabama
Physician work
1.000
Practice expense
0.875
Malpractice
0.566
Office calculation for 45333 in Alabama
ComponentRVULocality factorAdjusted
Physician work1.51× 1.0001.5100
Practice expense9.29× 0.8758.1288
Malpractice0.22× 0.5660.1245
Total RVUs9.7633
Conversion factor× 33.4009

Office rate, Alabama$326.10

Office: (1.51 × 1 + 9.29 × 0.875 + 0.22 × 0.566) × $33.4009 = $326.10

Facility: (1.51 × 1 + 0.86 × 0.875 + 0.22 × 0.566) × $33.4009 = $79.73

Open 45333 in the RVU calculator

Payment rules and modifiers for 45333

The CMS indicators that decide how 45333 is paid alongside other services.

CMS payment indicators · 45333

Flexible sigmoidoscopy, hot biopsy forceps removal

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

45333 without 51 · national office

$368.08

Flexible sigmoidoscopy, hot biopsy forceps removal

45333-51 · Second procedure: 50%

$184.04

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 45333

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

Codes related to 45333
CodeHow it relatesOffice range, Alabama
Used instead
45338Flexible sigmoidoscopy, snare lesion removalFlexible sigmoidoscopy with lesion removal by snare rather than hot biopsy forceps.$298.90
45330Flexible sigmoidoscopy, diagnosticDiagnostic flexible sigmoidoscopy when no lesion removal or other therapeutic intervention is performed.$190.40
Same family
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when tissue is sampled rather than removed with hot forceps.$285.80

How 45333 has changed in Alabama

45333 · Office / nonfacility

$326.10

Effective 2026-10-01

The base rate is $51.59 higher than on 2025-10-01, moving from $274.51 to $326.10 (18.8%).

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

    $274.51changed to$326.10

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.55 changed to 1.51
    • Practice expense RVU 7.83 changed to 9.29
    • Malpractice RVU 0.23 changed to 0.22
    • Practice expense GPCI 0.869 changed to 0.875
    • Malpractice GPCI 0.575 changed to 0.566

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $288.76changed to$274.51

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.04 changed to 7.83
    • Malpractice RVU 0.24 changed to 0.23

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $284.05changed to$288.76

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $300.84changed to$284.05

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.15 changed to 8.04
    • Malpractice RVU 0.23 changed to 0.24
    • Practice expense GPCI 0.878 changed to 0.869
    • Malpractice GPCI 0.748 changed to 0.575

  5. January 1, 2023

    RVU23A

    $318.79changed to$300.84

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.40 changed to 8.15
    • Malpractice RVU 0.22 changed to 0.23
    • Practice expense GPCI 0.888 changed to 0.878
    • Malpractice GPCI 0.921 changed to 0.748

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $318.63changed to$318.79

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.32 changed to 8.40
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $290.95changed to$318.63

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.15 changed to 8.32
    • Malpractice RVU 0.22 changed to 0.21
    • Practice expense GPCI 0.889 changed to 0.888
    • Malpractice GPCI 0.707 changed to 0.921

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $280.79changed to$290.95

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.88 changed to 7.15
    • Malpractice RVU 0.24 changed to 0.22
    • Practice expense GPCI 0.890 changed to 0.889
    • Malpractice GPCI 0.492 changed to 0.707

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $271.83changed to$280.79

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.61 changed to 6.88

    Held through RVU19B, RVU19C, RVU19D.

  10. April 1, 2018

    RVU18B

    No ratechanged to$271.83

    Held through RVU18C, RVU18D.

  11. 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, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$326.10$79.73RVU26D
2026-07-01$326.10$79.73RVU26C
2026-04-01$326.10$79.73RVU26B
2026-01-01$326.10$79.73RVU26A
2025-10-01$274.51$83.37RVU25D
2025-07-01$274.51$83.37RVU25C
2025-04-01$274.51$83.37RVU25B
2025-01-01$274.51$83.37RVU25A
2024-10-01$288.76$85.41RVU24D
2024-07-01$288.76$85.41RVU24C
2024-04-01$288.76$85.41RVU24B
2024-03-09$288.76$85.41RVU24AR
2024-01-01$284.05$84.01RVU24A
2023-10-01$300.84$87.51RVU23D
2023-07-01$300.84$87.51RVU23C
2023-04-01$300.84$87.51RVU23B
2023-01-01$300.84$87.51RVU23A
2022-10-01$318.79$90.77RVU22D
2022-07-01$318.79$90.77RVU22C
2022-04-01$318.79$90.77RVU22B
2022-01-01$318.79$90.77RVU22A
2021-10-01$318.63$90.89RVU21D
2021-07-01$318.63$90.89RVU21C
2021-04-01$318.63$90.89RVU21B
2021-01-01$318.63$90.89RVU21A
2020-10-01$290.95$91.71RVU20D
2020-07-01$290.95$91.71RVU20C
2020-04-01$290.95$91.71RVU20B
2020-01-01$290.95$91.71RVU20A
2019-10-01$280.79$90.27RVU19D
2019-07-01$280.79$90.27RVU19C
2019-04-01$280.79$90.27RVU19B
2019-01-01$280.79$90.27RVU19A
2018-10-01$271.83$90.81RVU18D
2018-07-01$271.83$90.81RVU18C
2018-04-01$271.83$90.81RVU18B
2018-01-01Rate data unavailableRate data unavailableRVU18AR1
2017-10-01Rate data unavailableRate data unavailableRVU17D
2017-07-01Rate data unavailableRate data unavailableRVU17C
2017-04-01Rate data unavailableRate data unavailableRVU17B
2017-01-01Rate data unavailableRate data unavailableRVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 45333 for an earlier date of service

Where the Alabama rate applies

Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.

  • Abanda
  • Abbeville
  • Adamsville
  • Addison
  • Akron
  • Alabaster
  • Albertville
  • Alexander City

Browse all communities in Alabama

45333 billing questions

When is this code appropriate instead of a biopsy code?

Use it when the lesion is removed with hot biopsy forceps. A procedure limited to taking tissue for examination is represented by the biopsy service.

How does this differ from snare removal?

This code identifies removal with hot biopsy forceps. Use the snare-removal code when the endoscopist removes the lesion using a snare.

How are related endoscopies in the same session paid?

CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each as an independent endoscopy.

What documentation supports reporting this service?

Document the flexible sigmoidoscopy, the lesion and its location, and that hot biopsy forceps were used to remove it.

Can modifier 50 or an assistant-at-surgery service be reported?

Modifier 50 is inappropriate for this service. CMS also bars assistant-at-surgery payment and does not permit co-surgeons or team surgery.

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 45333PPRRVU2026_Oct_nonQPP.csv, line 5,501 (RVU26D)
Geographic factors for AlabamaGPCI2026.csv, line 4 (RVU26D)

Open CMS sourceHow we calculate rates

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