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CPT code 45338: Flexible sigmoidoscopy, snare lesion removal2026 Medicare rate & RVUs in Nevada

Report this service when a clinician uses a flexible sigmoidoscope to remove a polyp or other lesion in the distal colon with a snare.

CMS RVU26DEffective Oct 1, 2026One payment locality6.6K Medicare services in 2024

In Nevada, Medicare pays $333.88 for 45338 in the office and $107.53 when it’s performed in a hospital or facility.

$333.88Office (non-facility)
$107.53Hospital or facility
−0.3%vs the national office rate ($335.01)

Check a contract rate as a % of Medicare · 45338 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 45338 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nevada
  2. What 45338 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 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.

How Nevada compares for 45338

Across 109 of 109 payment localities, the office rate for 45338 runs from $294.32 in Arkansas to $453.34 in San Benito County, CA. Nevada pays $333.88. The RVUs are the same everywhere; the geographic indexes change the dollars.

45338 in Nevada vs other payment areas
  1. Nevada · this page$333.88
  2. Los Angeles, CA · California$382.50+$48.62
  3. Washington, DC area · District of Columbia$385.82+$51.94
  4. Miami, FL · Florida$358.43+$24.55
  5. Chicago, IL · Illinois$347.59+$13.71
  6. Manhattan, NY · New York$386.28+$52.40
  7. Alaska · Alaska$381.55+$47.67

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

Every other payment area

45338 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$298.90$101.05
ArkansasArkansas$294.32$100.08
ArizonaArizona$325.75$106.64
Bakersfield, CACalifornia$357.96$110.13
Chico, CACalifornia$357.22$109.39
El Centro, CACalifornia$357.26$109.43
Fresno, CACalifornia$357.22$109.39
Hanford, CACalifornia$357.22$109.39

45338 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.

$294.32

$405.28

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

View every state and territory as a table
45338 office rate range by state
State / territoryOffice rate rangeLocalities
AK$381.551
AL$298.901
AR$294.321
AZ$325.751
CA$357.22–$453.3429
CO$350.611
CT$358.111
DC$385.821
DE$331.381
FL$327.78–$358.433
GA$308.55–$341.052
GU$367.101
HI$367.101
IA$307.891
ID$309.821
IL$317.10–$348.944
IN$311.751
KS$305.921
KY$305.461
LA$304.78–$320.812
MA$348.16–$387.242
MD$338.11–$385.823
ME$311.07–$329.592
MI$313.48–$331.642
MN$336.671
MO$298.93–$322.553
MS$296.711
MT$334.991
NC$314.591
ND$330.051
NE$309.811
NH$344.621
NJ$362.40–$381.362
NM$315.121
NV$333.881
NY$319.54–$395.565
OH$312.471
OK$305.341
OR$331.49–$362.792
PA$313.24–$348.482
PR$337.741
RI$343.951
SC$314.011
SD$329.471
TN$307.501
TX$311.03–$349.268
UT$318.571
VA$328.14–$385.822
VI$337.741
VT$328.291
WA$347.66–$395.812
WI$318.321
WV$304.571
WY$332.841

See 45338 in every payment locality

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

Office or facility?

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.

The exact Nevada inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,505

Code
45338
Physician work
2.00
Practice expense
7.78
Malpractice
0.25

GPCI2026.csv

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 45338 in Nevada
ComponentRVULocality factorAdjusted
Physician work2.00× 1.0002.0000
Practice expense7.78× 1.0017.7878
Malpractice0.25× 0.8330.2082
Total RVUs9.9960
Conversion factor× 33.4009

Office rate, Nevada$333.88

Office: (2 × 1 + 7.78 × 1.001 + 0.25 × 0.833) × $33.4009 = $333.88

Facility: (2 × 1 + 1.01 × 1.001 + 0.25 × 0.833) × $33.4009 = $107.53

Open 45338 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 45338

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

Codes related to 45338
CodeHow it relatesOffice range, Nevada
Used instead
45333Flexible sigmoidoscopy, hot biopsy forceps removalUses hot biopsy forceps or bipolar cautery rather than a snare to remove a lesion.$367.16
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when tissue is sampled rather than removed by snare.$322.49
45330Flexible sigmoidoscopy, diagnosticDiagnostic flexible sigmoidoscopy without the snare-removal service.$214.62
45308Lesion removal, rigid scope, cautery techniqueSnare removal by proctosigmoidoscopy rather than flexible sigmoidoscopy.$225.35

How 45338 has changed in Nevada

45338 · Office / nonfacility

$333.88

Effective 2026-10-01

The base rate is $48.65 higher than on 2025-10-01, moving from $285.23 to $333.88 (17.1%).

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

    $285.23changed to$333.88

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.05 changed to 2.00
    • Practice expense RVU 6.54 changed to 7.78
    • Malpractice RVU 0.27 changed to 0.25
    • Practice expense GPCI 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $297.24changed to$285.23

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.66 changed to 6.54
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $292.39changed to$297.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $305.85changed to$292.39

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.69 changed to 6.66
    • Malpractice GPCI 1.098 changed to 0.844

  5. January 1, 2023

    RVU23A

    $320.73changed to$305.85

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.87 changed to 6.69
    • Malpractice RVU 0.25 changed to 0.26
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $319.90changed to$320.73

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.77 changed to 6.87

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $292.76changed to$319.90

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.76 changed to 6.77
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $286.98changed to$292.76

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.56 changed to 5.76
    • Malpractice RVU 0.28 changed to 0.26
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $278.94changed to$286.98

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.34 changed to 5.56
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $280.02changed to$278.94

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.29 changed to 5.34
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $342.29changed to$280.02

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.15 changed to 2.05
    • Practice expense RVU 6.76 changed to 5.29
    • Malpractice RVU 0.30 changed to 0.29
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $338.18changed to$342.29

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 2.34 changed to 2.15
    • Practice expense RVU 6.39 changed to 6.76
    • Malpractice RVU 0.35 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $336.50changed to$338.18

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $336.98changed to$336.50

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.35 changed to 6.39
    • Malpractice RVU 0.33 changed to 0.35
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $357.42changed to$336.98

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.31 changed to 6.35
    • Malpractice RVU 0.35 changed to 0.33
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$357.42

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$333.88$107.53RVU26D
2026-07-01$333.88$107.53RVU26C
2026-04-01$333.88$107.53RVU26B
2026-01-01$333.88$107.53RVU26A
2025-10-01$285.23$114.44RVU25D
2025-07-01$285.23$114.44RVU25C
2025-04-01$285.23$114.44RVU25B
2025-01-01$285.23$114.44RVU25A
2024-10-01$297.24$117.15RVU24D
2024-07-01$297.24$117.15RVU24C
2024-04-01$297.24$117.15RVU24B
2024-03-09$297.24$117.15RVU24AR
2024-01-01$292.39$115.24RVU24A
2023-10-01$305.85$120.49RVU23D
2023-07-01$305.85$120.49RVU23C
2023-04-01$305.85$120.49RVU23B
2023-01-01$305.85$120.49RVU23A
2022-10-01$320.73$125.21RVU22D
2022-07-01$320.73$125.21RVU22C
2022-04-01$320.73$125.21RVU22B
2022-01-01$320.73$125.21RVU22A
2021-10-01$319.90$125.55RVU21D
2021-07-01$319.90$125.55RVU21C
2021-04-01$319.90$125.55RVU21B
2021-01-01$319.90$125.55RVU21A
2020-10-01$292.76$126.75RVU20D
2020-07-01$292.76$126.75RVU20C
2020-04-01$292.76$126.75RVU20B
2020-01-01$292.76$126.75RVU20A
2019-10-01$286.98$126.08RVU19D
2019-07-01$286.98$126.08RVU19C
2019-04-01$286.98$126.08RVU19B
2019-01-01$286.98$126.08RVU19A
2018-10-01$278.94$127.37RVU18D
2018-07-01$278.94$127.37RVU18C
2018-04-01$278.94$127.37RVU18B
2018-01-01$278.94$127.37RVU18AR1
2017-10-01$280.02$128.24RVU17D
2017-07-01$280.02$128.24RVU17C
2017-04-01$280.02$128.24RVU17B
2017-01-01$280.02$128.24RVU17A
2016-10-01$342.29$134.20RVU16D
2016-07-01$342.29$134.20RVU16C
2016-04-01$342.29$134.20RVU16B
2016-01-01$342.29$134.20RVU16A
2015-10-01$338.18$147.84RVU15D
2015-07-01$338.18$147.84RVU15C
2015-04-01$336.50$147.10RVU15B
2015-01-01$336.50$147.10RVU15A
2014-10-01$336.98$148.77RVU14D
2014-07-01$336.98$148.77RVU14C
2014-04-01$336.98$148.77RVU14B
2014-01-01$336.98$148.77RVU14A
2013-10-01$357.42$149.36RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 45338 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

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
RVUs for 45338PPRRVU2026_Oct_nonQPP.csv, line 5,505 (RVU26D)
Geographic factors for NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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