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

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 Tennessee, Medicare pays $307.50 for 45338 in the office and $101.95 when it’s performed in a hospital or facility.

$307.50Office (non-facility)
$101.95Hospital or facility
−8.2%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 Tennessee
  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 Tennessee 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. Tennessee pays $307.50. The RVUs are the same everywhere; the geographic indexes change the dollars.

45338 in Tennessee vs other payment areas
  1. Tennessee · this page$307.50
  2. Los Angeles, CA · California$382.50+$75.00
  3. Washington, DC area · District of Columbia$385.82+$78.32
  4. Miami, FL · Florida$358.43+$50.93
  5. Chicago, IL · Illinois$347.59+$40.09
  6. Manhattan, NY · New York$386.28+$78.78
  7. Alaska · Alaska$381.55+$74.05

Other areas in Tennessee 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 Tennessee 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

95

Locality
Tennessee
Physician work
1.000
Practice expense
0.909
Malpractice
0.537
Office calculation for 45338 in Tennessee
ComponentRVULocality factorAdjusted
Physician work2.00× 1.0002.0000
Practice expense7.78× 0.9097.0720
Malpractice0.25× 0.5370.1343
Total RVUs9.2063
Conversion factor× 33.4009

Office rate, Tennessee$307.50

Office: (2 × 1 + 7.78 × 0.909 + 0.25 × 0.537) × $33.4009 = $307.50

Facility: (2 × 1 + 1.01 × 0.909 + 0.25 × 0.537) × $33.4009 = $101.95

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, Tennessee
Used instead
45333Flexible sigmoidoscopy, hot biopsy forceps removalUses hot biopsy forceps or bipolar cautery rather than a snare to remove a lesion.$336.44
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when tissue is sampled rather than removed by snare.$295.23
45330Flexible sigmoidoscopy, diagnosticDiagnostic flexible sigmoidoscopy without the snare-removal service.$196.53
45308Lesion removal, rigid scope, cautery techniqueSnare removal by proctosigmoidoscopy rather than flexible sigmoidoscopy.$205.97

How 45338 has changed in Tennessee

45338 · Office / nonfacility

$307.50

Effective 2026-10-01

The base rate is $46.89 higher than on 2025-10-01, moving from $260.61 to $307.50 (18.0%).

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

    $260.61changed to$307.50

    • 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 0.896 changed to 0.909
    • Malpractice GPCI 0.544 changed to 0.537

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $271.59changed to$260.61

    • 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

    $267.15changed to$271.59

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $276.71changed to$267.15

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.69 changed to 6.66
    • Practice expense GPCI 0.894 changed to 0.896
    • Malpractice GPCI 0.518 changed to 0.544

  5. January 1, 2023

    RVU23A

    $287.27changed to$276.71

    • 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
    • Practice expense GPCI 0.892 changed to 0.894
    • Malpractice GPCI 0.492 changed to 0.518

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $286.54changed to$287.27

    • 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

    $265.22changed to$286.54

    • 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
    • Practice expense GPCI 0.897 changed to 0.892
    • Malpractice GPCI 0.509 changed to 0.492

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $259.73changed to$265.22

    • 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
    • Practice expense GPCI 0.901 changed to 0.897
    • Malpractice GPCI 0.526 changed to 0.509

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $252.50changed to$259.73

    • 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. April 1, 2018

    RVU18B

    No ratechanged to$252.50

    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$307.50$101.95RVU26D
2026-07-01$307.50$101.95RVU26C
2026-04-01$307.50$101.95RVU26B
2026-01-01$307.50$101.95RVU26A
2025-10-01$260.61$107.58RVU25D
2025-07-01$260.61$107.58RVU25C
2025-04-01$260.61$107.58RVU25B
2025-01-01$260.61$107.58RVU25A
2024-10-01$271.59$110.23RVU24D
2024-07-01$271.59$110.23RVU24C
2024-04-01$271.59$110.23RVU24B
2024-03-09$271.59$110.23RVU24AR
2024-01-01$267.15$108.43RVU24A
2023-10-01$276.71$110.99RVU23D
2023-07-01$276.71$110.99RVU23C
2023-04-01$276.71$110.99RVU23B
2023-01-01$276.71$110.99RVU23A
2022-10-01$287.27$112.86RVU22D
2022-07-01$287.27$112.86RVU22C
2022-04-01$287.27$112.86RVU22B
2022-01-01$287.27$112.86RVU22A
2021-10-01$286.54$113.17RVU21D
2021-07-01$286.54$113.17RVU21C
2021-04-01$286.54$113.17RVU21B
2021-01-01$286.54$113.17RVU21A
2020-10-01$265.22$116.31RVU20D
2020-07-01$265.22$116.31RVU20C
2020-04-01$265.22$116.31RVU20B
2020-01-01$265.22$116.31RVU20A
2019-10-01$259.73$117.18RVU19D
2019-07-01$259.73$117.18RVU19C
2019-04-01$259.73$117.18RVU19B
2019-01-01$259.73$117.18RVU19A
2018-10-01$252.50$118.21RVU18D
2018-07-01$252.50$118.21RVU18C
2018-04-01$252.50$118.21RVU18B
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 45338 for an earlier date of service

Where the Tennessee rate applies

Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.

  • Adams
  • Adamsville
  • Alamo
  • Alcoa
  • Alexandria
  • Algood
  • Allardt
  • Altamont

Browse all communities in Tennessee

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 TennesseeGPCI2026.csv, line 95 (RVU26D)

Open CMS sourceHow we calculate rates

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