CPT code 45338: Flexible sigmoidoscopy, snare lesion removal2026 Medicare rate & RVUs
Report this service when a clinician uses a flexible sigmoidoscope to remove a polyp or other lesion in the distal colon with a snare.
Medicare pays $335.01 for 45338 nationally in the office and $108.89 in a hospital or facility. Local office rates run $294.32–$453.34.
Medicare rate · 45338
Flexible sigmoidoscopy, snare lesion removal
- Work RVUs
- 2
- Total RVUs
- 10.03
- Global days
- 000
National rate · 2026
$335.01
Office setting, before claim adjustments.
See every locality for 45338 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 45338 covers
A clinician advances a flexible scope through the rectum to examine the distal colon and uses a snare to remove a lesion, such as a polyp found in the sigmoid colon. Gastroenterologists and colorectal surgeons commonly perform the procedure in an endoscopy unit or hospital outpatient department. The removed tissue may be submitted for pathologic examination. This code reflects snare removal, not a procedure limited to inspecting the bowel or sampling tissue with biopsy forceps.
Report the service when the procedure record supports flexible sigmoidoscopy and snare removal; document the lesion site and removal technique. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service; 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.
Where 45338 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$294.32 to $453.34
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $298.90 | $101.05 |
| Alaska | $381.55 | $140.73 |
| Arizona | $325.75 | $106.64 |
| Arkansas | $294.32 | $100.08 |
| Atlanta, GA | $341.05 | $111.31 |
| Austin, TX | $349.26 | $110.03 |
| Bakersfield, CA | $357.96 | $110.13 |
| Baltimore area, MD | $357.03 | $114.40 |
| Beaumont, TX | $311.03 | $105.26 |
| Brazoria, TX | $331.37 | $107.28 |
| Chicago, IL | $347.59 | $120.34 |
| Chico, CA | $357.22 | $109.39 |
| Colorado | $350.61 | $110.02 |
| Connecticut | $358.11 | $114.57 |
| Dallas, TX | $333.39 | $108.17 |
| Delaware | $331.38 | $107.97 |
| Detroit, MI | $331.64 | $113.43 |
| East St. Louis, IL | $322.69 | $114.66 |
| El Centro, CA | $357.26 | $109.43 |
| Fort Lauderdale, FL | $345.14 | $116.07 |
| Fort Worth, TX | $330.90 | $107.94 |
| Fresno, CA | $357.22 | $109.39 |
| Galveston, TX | $332.29 | $107.75 |
| Hanford, CA | $357.22 | $109.39 |
| Hawaii, Guam, HI | $367.10 | $109.99 |
| Houston, TX | $336.87 | $112.32 |
| Idaho | $309.82 | $101.79 |
| Indiana | $311.75 | $102.13 |
| Iowa | $307.89 | $100.98 |
| Kansas | $305.92 | $101.51 |
| Kentucky | $305.46 | $104.43 |
| King County, WA | $395.81 | $118.36 |
| Los Angeles, CA | $382.50 | $114.99 |
| Madera, CA | $357.22 | $109.39 |
| Manhattan, NY | $386.28 | $123.52 |
| Marin County, CA | $443.38 | $124.55 |
| Merced, CA | $357.22 | $109.39 |
| Metropolitan Boston, MA | $387.24 | $117.25 |
| Metropolitan Kansas City, MO | $318.97 | $106.64 |
| Metropolitan Philadelphia, PA | $348.48 | $113.08 |
| Metropolitan St. Louis, MO | $322.55 | $107.28 |
| Miami, FL | $358.43 | $123.04 |
| Minnesota | $336.67 | $103.99 |
| Mississippi | $296.71 | $102.02 |
| Modesto, CA | $357.22 | $109.39 |
| Montana | $334.99 | $108.87 |
| Napa, CA | $417.75 | $119.71 |
| Nebraska | $309.81 | $101.10 |
| Nevada | $333.88 | $107.53 |
| New Hampshire | $344.62 | $109.23 |
| New Mexico | $315.12 | $107.77 |
| New Orleans, LA | $320.81 | $108.03 |
| North Carolina | $314.59 | $103.61 |
| North Dakota | $330.05 | $103.93 |
| Northern New Jersey | $381.36 | $119.06 |
| NYC suburbs and Long Island, NY | $395.56 | $126.69 |
| Ohio | $312.47 | $106.02 |
| Oklahoma | $305.34 | $103.42 |
| Oxnard, CA | $381.03 | $113.75 |
| Portland, OR | $362.79 | $111.56 |
| Poughkeepsie and northern NYC suburbs, NY | $364.46 | $116.85 |
| Puerto Rico | $337.74 | $109.13 |
| Queens, NY | $390.27 | $122.99 |
| Redding, CA | $357.22 | $109.39 |
| Rest of California | $357.22 | $109.39 |
| Rest of Florida | $327.78 | $111.60 |
| Rest of Georgia | $308.55 | $106.85 |
| Rest of Illinois | $317.10 | $110.65 |
| Rest of Louisiana | $304.78 | $104.66 |
| Rest of Maine | $311.07 | $103.03 |
| Rest of Maryland | $338.11 | $109.28 |
| Rest of Massachusetts | $348.16 | $110.05 |
| Rest of Michigan | $313.48 | $107.03 |
| Rest of Missouri | $298.93 | $104.01 |
| Rest of New Jersey | $362.40 | $115.47 |
| Rest of New York | $319.54 | $104.72 |
| Rest of Oregon | $331.49 | $106.27 |
| Rest of Pennsylvania | $313.24 | $105.66 |
| Rest of Texas | $320.95 | $106.36 |
| Rest of Washington | $347.66 | $109.55 |
| Rhode Island | $343.95 | $110.37 |
| Riverside, CA | $359.93 | $112.10 |
| Sacramento, CA | $375.90 | $112.92 |
| Salinas, CA | $374.52 | $112.45 |
| San Benito County, CA | $453.34 | $127.27 |
| San Diego, CA | $384.12 | $113.68 |
| San Francisco, CA | $443.10 | $124.26 |
| San Luis Obispo, CA | $368.39 | $110.84 |
| Santa Clara County, CA | $452.18 | $126.11 |
| Santa Cruz, CA | $388.41 | $113.67 |
| Santa Maria, CA | $376.14 | $112.48 |
| Santa Rosa, CA | $392.39 | $114.71 |
| South Carolina | $314.01 | $105.07 |
| South Dakota | $329.47 | $103.34 |
| Southern Maine, ME | $329.59 | $105.50 |
| Stockton, CA | $357.22 | $109.39 |
| Suburban Chicago, IL | $348.94 | $116.71 |
| Tennessee | $307.50 | $101.95 |
| Utah | $318.57 | $106.01 |
| Vallejo, CA | $417.34 | $119.31 |
| Vermont | $328.29 | $104.42 |
| Virgin Islands, VI | $337.74 | $109.13 |
| Virginia | $328.14 | $105.86 |
| Visalia, CA | $357.22 | $109.39 |
| Washington, DC area | $385.82 | $119.44 |
| West Virginia | $304.57 | $108.07 |
| Wisconsin | $318.32 | $101.69 |
| Wyoming | $332.84 | $106.72 |
| Yuba City, CA | $357.22 | $109.39 |
45338 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.
$294.32
$405.28
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 | $381.55 | 1 |
| AL | $298.90 | 1 |
| AR | $294.32 | 1 |
| AZ | $325.75 | 1 |
| CA | $357.22–$453.34 | 29 |
| CO | $350.61 | 1 |
| CT | $358.11 | 1 |
| DC | $385.82 | 1 |
| DE | $331.38 | 1 |
| FL | $327.78–$358.43 | 3 |
| GA | $308.55–$341.05 | 2 |
| GU | $367.10 | 1 |
| HI | $367.10 | 1 |
| IA | $307.89 | 1 |
| ID | $309.82 | 1 |
| IL | $317.10–$348.94 | 4 |
| IN | $311.75 | 1 |
| KS | $305.92 | 1 |
| KY | $305.46 | 1 |
| LA | $304.78–$320.81 | 2 |
| MA | $348.16–$387.24 | 2 |
| MD | $338.11–$385.82 | 3 |
| ME | $311.07–$329.59 | 2 |
| MI | $313.48–$331.64 | 2 |
| MN | $336.67 | 1 |
| MO | $298.93–$322.55 | 3 |
| MS | $296.71 | 1 |
| MT | $334.99 | 1 |
| NC | $314.59 | 1 |
| ND | $330.05 | 1 |
| NE | $309.81 | 1 |
| NH | $344.62 | 1 |
| NJ | $362.40–$381.36 | 2 |
| NM | $315.12 | 1 |
| NV | $333.88 | 1 |
| NY | $319.54–$395.56 | 5 |
| OH | $312.47 | 1 |
| OK | $305.34 | 1 |
| OR | $331.49–$362.79 | 2 |
| PA | $313.24–$348.48 | 2 |
| PR | $337.74 | 1 |
| RI | $343.95 | 1 |
| SC | $314.01 | 1 |
| SD | $329.47 | 1 |
| TN | $307.50 | 1 |
| TX | $311.03–$349.26 | 8 |
| UT | $318.57 | 1 |
| VA | $328.14–$385.82 | 2 |
| VI | $337.74 | 1 |
| VT | $328.29 | 1 |
| WA | $347.66–$395.81 | 2 |
| WI | $318.32 | 1 |
| WV | $304.57 | 1 |
| WY | $332.84 | 1 |
How the 45338 rate is calculated
Each of 45338’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 · 45338
RVUs × geographic indexes × conversion factor
Work2.00
2.00 RVUs× 1.000 GPCI
Practice expense7.78
7.78 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
10.0300
Conversion factor
$33.4009
Medicare rate
$335.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45338
The CMS indicators that decide how 45338 is paid alongside other services.
CMS payment indicators · 45338
Flexible sigmoidoscopy, snare lesion removal
| 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
45338 without 51 · national office
$335.01
Flexible sigmoidoscopy, snare lesion removal
45338-51 · Second procedure: 50%
$167.51
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%).
45338 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45333Flexible sigmoidoscopyHot biopsy forceps removal
- Choose 45338 when a snare removes the lesion. Choose 45333 when removal is performed with hot biopsy forceps or bipolar cautery.
- 45331SigmoidoscopyWith biopsy
- 45331 represents biopsy during flexible sigmoidoscopy; 45338 represents removal with a snare.
- 45330Flexible sigmoidoscopyDiagnostic
- 45330 is diagnostic flexible sigmoidoscopy without lesion removal. Use 45338 when the examination includes snare removal.
- 45308Lesion removalRigid scope, cautery technique
- Both involve snare removal, but 45308 is for proctosigmoidoscopy; 45338 is for flexible sigmoidoscopy.
45338 billing questions
How is this different from 45333?
Use 45338 for snare removal. Code 45333 describes removal using hot biopsy forceps or bipolar cautery.
Can this be reported for a biopsy alone?
No. A biopsy without snare removal is represented by the biopsy service, such as 45331.
Should the code be billed once for each polyp?
The service is the snare-removal procedure, not a per-polyp unit. Document the lesions treated and the technique used.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together; payment is not treated as unrelated procedures.
Is modifier 50 appropriate, or can an assistant be paid?
Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this code.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure's 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
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