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

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 Houston, TX, Medicare pays $328.00 for 45335 in the office and $64.32 when it’s performed in a hospital or facility.

$328.00Office (non-facility)
$64.32Hospital or facility
+0.0%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 Houston, TX
  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 Houston, TX 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. Houston, TX pays $328.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

45335 in Houston, TX vs other payment areas
  1. Houston, TX · this page$328.00
  2. Austin, TX · Texas$344.33+$16.33
  3. Beaumont, TX · Texas$301.60−$26.40
  4. Brazoria, TX · Texas$324.63−$3.37
  5. Dallas, TX · Texas$326.48−$1.52
  6. Fort Worth, TX · Texas$323.64−$4.36
  7. Galveston, TX · Texas$325.44−$2.56

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

Every other payment area

45335 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$312.77$60.78
Los Angeles, CACalifornia$380.80$66.67
Washington, DC areaDistrict of Columbia$381.89$69.09
Miami, FLFlorida$347.02$70.60
Chicago, ILIllinois$335.74$68.87
Manhattan, NYNew York$379.81$71.25
AlaskaAlaska$361.59$78.79
AlabamaAlabama$289.77$57.42

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 45335 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work1.01× 1.0081.0181
Practice expense8.67× 0.9938.6093
Malpractice0.14× 1.3760.1926
Total RVUs9.8200
Conversion factor× 33.4009

Office rate, Houston, TX$328.00

Office: (1.01 × 1.008 + 8.67 × 0.993 + 0.14 × 1.376) × $33.4009 = $328.00

Facility: (1.01 × 1.008 + 0.72 × 0.993 + 0.14 × 1.376) × $33.4009 = $64.32

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, Houston, TX
Used instead
45330Flexible sigmoidoscopy, diagnosticDiagnostic sigmoidoscopy for an examination without submucosal injection.$215.54
Same family
45331Sigmoidoscopy, with biopsySigmoidoscopy with biopsy; selected when tissue sampling is performed.$323.07
45333Flexible sigmoidoscopy, hot biopsy forceps removalSigmoidoscopy with polyp removal, rather than submucosal injection alone.$369.07
45334Flexible sigmoidoscopy, endoscopic bleeding controlSigmoidoscopy with treatment of bleeding.$544.08

How 45335 has changed in Houston, TX

45335 · Office / nonfacility

$328.00

Effective 2026-10-01

The base rate is $48.14 higher than on 2025-10-01, moving from $279.86 to $328.00 (17.2%).

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

    $279.86changed to$328.00

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $293.08changed to$279.86

    • 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

    $288.29changed to$293.08

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $303.88changed to$288.29

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.62 changed to 7.53
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $320.06changed to$303.88

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $315.08changed to$320.06

    • 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

    $278.78changed to$315.08

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $260.66changed to$278.78

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $243.62changed to$260.66

    • 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

    $240.15changed to$243.62

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.44 changed to 5.50
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $295.60changed to$240.15

    • 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
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $283.31changed to$295.60

    • 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

    $281.90changed to$283.31

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $279.47changed to$281.90

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $296.66changed to$279.47

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $296.66

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$328.00$64.32RVU26D
2026-07-01$328.00$64.32RVU26C
2026-04-01$328.00$64.32RVU26B
2026-01-01$328.00$64.32RVU26A
2025-10-01$279.86$68.01RVU25D
2025-07-01$279.86$68.01RVU25C
2025-04-01$279.86$68.01RVU25B
2025-01-01$279.86$68.01RVU25A
2024-10-01$293.08$68.71RVU24D
2024-07-01$293.08$68.71RVU24C
2024-04-01$293.08$68.71RVU24B
2024-03-09$293.08$68.71RVU24AR
2024-01-01$288.29$67.59RVU24A
2023-10-01$303.88$68.73RVU23D
2023-07-01$303.88$68.73RVU23C
2023-04-01$303.88$68.73RVU23B
2023-01-01$303.88$68.73RVU23A
2022-10-01$320.06$68.30RVU22D
2022-07-01$320.06$68.30RVU22C
2022-04-01$320.06$68.30RVU22B
2022-01-01$320.06$68.30RVU22A
2021-10-01$315.08$69.13RVU21D
2021-07-01$315.08$69.13RVU21C
2021-04-01$315.08$69.13RVU21B
2021-01-01$315.08$69.13RVU21A
2020-10-01$278.78$70.06RVU20D
2020-07-01$278.78$70.06RVU20C
2020-04-01$278.78$70.06RVU20B
2020-01-01$278.78$70.06RVU20A
2019-10-01$260.66$70.28RVU19D
2019-07-01$260.66$70.28RVU19C
2019-04-01$260.66$70.28RVU19B
2019-01-01$260.66$70.28RVU19A
2018-10-01$243.62$70.57RVU18D
2018-07-01$243.62$70.57RVU18C
2018-04-01$243.62$70.57RVU18B
2018-01-01$243.62$70.57RVU18AR1
2017-10-01$240.15$70.68RVU17D
2017-07-01$240.15$70.68RVU17C
2017-04-01$240.15$70.68RVU17B
2017-01-01$240.15$70.68RVU17A
2016-10-01$295.60$75.88RVU16D
2016-07-01$295.60$75.88RVU16C
2016-04-01$295.60$75.88RVU16B
2016-01-01$295.60$75.88RVU16A
2015-10-01$283.31$96.06RVU15D
2015-07-01$283.31$96.06RVU15C
2015-04-01$281.90$95.58RVU15B
2015-01-01$281.90$95.58RVU15A
2014-10-01$279.47$94.96RVU14D
2014-07-01$279.47$94.96RVU14C
2014-04-01$279.47$94.96RVU14B
2014-01-01$279.47$94.96RVU14A
2013-10-01$296.66$94.50RVU13D
2013-07-01$296.66$94.50RVU13C
2013-04-01$296.66$94.50RVU13B
2013-01-01$296.66$94.50RVU13AR

Price 45335 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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