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CPT code 45335: Flexible sigmoidoscopy, submucosal injection2026 Medicare rate & RVUs in Iowa

Reports flexible sigmoidoscopy when the endoscopist injects a substance into the bowel-wall submucosa, such as to mark or lift a target.

CMS RVU26DEffective Oct 1, 2026One payment locality3.1K Medicare services in 2024

In Iowa, Medicare pays $300.56 for 45335 in the office and $57.60 when it’s performed in a hospital or facility.

$300.56Office (non-facility)
$57.60Hospital or facility
−8.4%vs the national office rate ($328.00)

Check a contract rate as a % of Medicare · 45335 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 45335 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 45335 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 45335 covers

During flexible sigmoidoscopy, the endoscopist advances a flexible instrument through the rectum into the sigmoid colon and injects a substance beneath the mucosal lining under direct visualization. Injections may mark a site for later identification or raise a lesion for endoscopic treatment. Gastroenterologists and colorectal surgeons commonly perform the service in an endoscopy unit, ambulatory surgery center, or hospital outpatient department.

Report this code when the documented sigmoidoscopy includes submucosal injection; a diagnostic examination alone, biopsy, or removal is a different service. The procedure note should identify the injection site, substance or purpose when known, and the endoscopic work performed. 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. CMS does not pay an assistant at surgery, 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 Iowa compares for 45335

Across 109 of 109 payment localities, the office rate for 45335 runs from $284.90 in Arkansas to $457.53 in San Benito County, CA. Iowa pays $300.56. The RVUs are the same everywhere; the geographic indexes change the dollars.

45335 in Iowa vs other payment areas
  1. Iowa · this page$300.56
  2. Los Angeles, CA · California$380.80+$80.24
  3. Washington, DC area · District of Columbia$381.89+$81.33
  4. Miami, FL · Florida$347.02+$46.46
  5. Chicago, IL · Illinois$335.74+$35.18
  6. Manhattan, NY · New York$379.81+$79.25
  7. Alaska · Alaska$361.59+$61.03

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

Every other payment area

45335 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$289.77$57.42
ArkansasArkansas$284.90$56.80
ArizonaArizona$318.35$61.04
Bakersfield, CACalifornia$354.61$63.58
Chico, CACalifornia$354.20$63.17
El Centro, CACalifornia$354.22$63.20
Fresno, CACalifornia$354.20$63.17
Hanford, CACalifornia$354.20$63.17

45335 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.

$284.90

$405.87

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

View every state and territory as a table
45335 office rate range by state
State / territoryOffice rate rangeLocalities
AK$361.591
AL$289.771
AR$284.901
AZ$318.351
CA$354.20–$457.5329
CO$345.911
CT$351.951
DC$381.891
DE$324.221
FL$317.61–$347.023
GA$297.62–$333.672
GU$365.701
HI$365.701
IA$300.561
ID$302.371
IL$305.44–$339.664
IN$304.451
KS$297.881
KY$295.461
LA$294.50–$311.552
MA$342.94–$385.052
MD$331.43–$381.893
ME$303.06–$323.672
MI$303.41–$321.072
MN$333.101
MO$287.91–$314.113
MS$286.521
MT$327.991
NC$306.911
ND$325.221
NE$302.791
NH$339.291
NJ$356.44–$376.772
NM$304.901
NV$327.511
NY$312.13–$388.905
OH$302.841
OK$295.971
OR$325.45–$359.482
PA$303.99–$341.382
PR$331.111
RI$337.691
SC$305.291
SD$324.891
TN$299.481
TX$301.60–$344.338
UT$310.141
VA$321.70–$381.892
VI$331.111
VT$322.791
WA$342.67–$394.562
WI$312.601
WV$292.081
WY$326.781

See 45335 in every payment locality

How the 45335 rate is calculated

Each of 45335’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 · 45335

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.01

1.01 RVUs× 1.000 GPCI

Practice expense8.67

8.67 RVUs× 1.000 GPCI

Malpractice0.14

0.14 RVUs× 1.000 GPCI

Adjusted RVUs

9.8200

Conversion factor

$33.4009

Medicare rate

$328.00

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

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,503

Code
45335
Physician work
1.01
Practice expense
8.67
Malpractice
0.14

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 45335 in Iowa
ComponentRVULocality factorAdjusted
Physician work1.01× 1.0001.0100
Practice expense8.67× 0.9157.9331
Malpractice0.14× 0.3970.0556
Total RVUs8.9986
Conversion factor× 33.4009

Office rate, Iowa$300.56

Office: (1.01 × 1 + 8.67 × 0.915 + 0.14 × 0.397) × $33.4009 = $300.56

Facility: (1.01 × 1 + 0.72 × 0.915 + 0.14 × 0.397) × $33.4009 = $57.60

Open 45335 in the RVU calculator

Payment rules and modifiers for 45335

The CMS indicators that decide how 45335 is paid alongside other services.

CMS payment indicators · 45335

Flexible sigmoidoscopy, submucosal injection

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

45335 without 51 · national office

$328.00

Flexible sigmoidoscopy, submucosal injection

45335-51 · Second procedure: 50%

$164.00

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 45335

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

Codes related to 45335
CodeHow it relatesOffice range, Iowa
Used instead
45330Flexible sigmoidoscopy, diagnosticDiagnostic sigmoidoscopy for an examination without submucosal injection.$197.07
Same family
45331Sigmoidoscopy, with biopsySigmoidoscopy with biopsy; selected when tissue sampling is performed.$296.26
45333Flexible sigmoidoscopy, hot biopsy forceps removalSigmoidoscopy with polyp removal, rather than submucosal injection alone.$337.27
45334Flexible sigmoidoscopy, endoscopic bleeding controlSigmoidoscopy with treatment of bleeding.$499.58

How 45335 has changed in Iowa

45335 · Office / nonfacility

$300.56

Effective 2026-10-01

The base rate is $47.49 higher than on 2025-10-01, moving from $253.07 to $300.56 (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

    $253.07changed to$300.56

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.04 changed to 1.01
    • Practice expense RVU 7.35 changed to 8.67
    • Malpractice RVU 0.16 changed to 0.14
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $265.60changed to$253.07

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.53 changed to 7.35
    • Malpractice RVU 0.14 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $261.26changed to$265.60

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $272.32changed to$261.26

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.62 changed to 7.53
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $283.84changed to$272.32

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.84 changed to 7.62
    • Malpractice RVU 0.12 changed to 0.14
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $279.21changed to$283.84

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.61 changed to 7.84
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $249.34changed to$279.21

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.41 changed to 7.61
    • Malpractice RVU 0.13 changed to 0.14
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $234.58changed to$249.34

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.96 changed to 6.41
    • Malpractice RVU 0.15 changed to 0.13
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $219.31changed to$234.58

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.50 changed to 5.96

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $215.89changed to$219.31

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.44 changed to 5.50
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $265.00changed to$215.89

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 1.14 changed to 1.04
    • Practice expense RVU 6.90 changed to 5.44
    • Malpractice RVU 0.16 changed to 0.15
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $254.22changed to$265.00

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 1.46 changed to 1.14
    • Practice expense RVU 6.14 changed to 6.90
    • Malpractice RVU 0.23 changed to 0.16

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $252.96changed to$254.22

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $250.64changed to$252.96

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.09 changed to 6.14
    • Malpractice RVU 0.22 changed to 0.23
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $265.09changed to$250.64

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.02 changed to 6.09
    • Malpractice RVU 0.23 changed to 0.22
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $265.09

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$300.56$57.60RVU26D
2026-07-01$300.56$57.60RVU26C
2026-04-01$300.56$57.60RVU26B
2026-01-01$300.56$57.60RVU26A
2025-10-01$253.07$60.22RVU25D
2025-07-01$253.07$60.22RVU25C
2025-04-01$253.07$60.22RVU25B
2025-01-01$253.07$60.22RVU25A
2024-10-01$265.60$61.37RVU24D
2024-07-01$265.60$61.37RVU24C
2024-04-01$265.60$61.37RVU24B
2024-03-09$265.60$61.37RVU24AR
2024-01-01$261.26$60.36RVU24A
2023-10-01$272.32$61.70RVU23D
2023-07-01$272.32$61.70RVU23C
2023-04-01$272.32$61.70RVU23B
2023-01-01$272.32$61.70RVU23A
2022-10-01$283.84$61.92RVU22D
2022-07-01$283.84$61.92RVU22C
2022-04-01$283.84$61.92RVU22B
2022-01-01$283.84$61.92RVU22A
2021-10-01$279.21$62.42RVU21D
2021-07-01$279.21$62.42RVU21C
2021-04-01$279.21$62.42RVU21B
2021-01-01$279.21$62.42RVU21A
2020-10-01$249.34$63.75RVU20D
2020-07-01$249.34$63.75RVU20C
2020-04-01$249.34$63.75RVU20B
2020-01-01$249.34$63.75RVU20A
2019-10-01$234.58$63.96RVU19D
2019-07-01$234.58$63.96RVU19C
2019-04-01$234.58$63.96RVU19B
2019-01-01$234.58$63.96RVU19A
2018-10-01$219.31$64.21RVU18D
2018-07-01$219.31$64.21RVU18C
2018-04-01$219.31$64.21RVU18B
2018-01-01$219.31$64.21RVU18AR1
2017-10-01$215.89$64.39RVU17D
2017-07-01$215.89$64.39RVU17C
2017-04-01$215.89$64.39RVU17B
2017-01-01$215.89$64.39RVU17A
2016-10-01$265.00$69.31RVU16D
2016-07-01$265.00$69.31RVU16C
2016-04-01$265.00$69.31RVU16B
2016-01-01$265.00$69.31RVU16A
2015-10-01$254.22$87.45RVU15D
2015-07-01$254.22$87.45RVU15C
2015-04-01$252.96$87.01RVU15B
2015-01-01$252.96$87.01RVU15A
2014-10-01$250.64$86.72RVU14D
2014-07-01$250.64$86.72RVU14C
2014-04-01$250.64$86.72RVU14B
2014-01-01$250.64$86.72RVU14A
2013-10-01$265.09$86.14RVU13D
2013-07-01$265.09$86.14RVU13C
2013-04-01$265.09$86.14RVU13B
2013-01-01$265.09$86.14RVU13AR

Price 45335 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

45335 billing questions

When is this code appropriate instead of a diagnostic sigmoidoscopy?

Use it when the endoscopist performs a submucosal injection during the examination. A diagnostic examination without injection is reported with the diagnostic sigmoidoscopy code.

Can the diagnostic examination be billed separately?

The sigmoidoscopy is part of the service represented by this code; do not separately report a diagnostic examination for the same scope session.

What documentation supports the injection service?

Document the injection site and the substance or clinical purpose when known, along with the endoscopic findings and work performed.

Should modifier 50 be used for injections on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

How does CMS price this with another endoscopy on the same date?

When related endoscopies are performed together, CMS endoscopy family pricing applies. Same-day preoperative and postoperative care is included in this code's 0-day global period.

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 45335PPRRVU2026_Oct_nonQPP.csv, line 5,503 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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