CPT code 45342: Sigmoidoscopy, ultrasound-guided tissue sampling2026 Medicare rate & RVUs in Georgia
Reports flexible sigmoidoscopy with endoscopic ultrasound-guided needle sampling of a distal intestinal lesion or nearby target for tissue diagnosis.
CMS doesn’t publish an office rate for 45342 in Georgia.
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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What 45342 covers
This procedure combines flexible examination of the rectum and sigmoid colon with endoscopic ultrasound imaging and needle aspiration or biopsy of a target. Gastroenterologists commonly use it to sample a subepithelial rectal or sigmoid lesion, or a nearby structure, when routine mucosal forceps biopsy may not reach the target. It is typically performed in an endoscopy suite, hospital outpatient department, or ambulatory surgery center.
Report 45342 when the endoscopic ultrasound is used to guide needle tissue sampling; documentation should identify the target and show that ultrasound guidance and sampling were performed. A standard mucosal biopsy without ultrasound-guided needle sampling is a different service. 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 for this service. Medicare does not pay an assistant at surgery, and 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 45342 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta, GA | Unavailable | $155.03 |
| Rest of Georgia | Unavailable | $149.37 |
How the 45342 rate is calculated
Each of 45342’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 · 45342
RVUs × geographic indexes × conversion factor
Work2.91
2.91 RVUs× 1.000 GPCI
Practice expense1.27
1.27 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
4.5400
Conversion factor
$33.4009
Medicare rate
$151.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45342
The CMS indicators that decide how 45342 is paid alongside other services.
CMS payment indicators · 45342
Sigmoidoscopy, ultrasound-guided tissue sampling
| 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
45342 without 51 · national facility
$151.64
Sigmoidoscopy, ultrasound-guided tissue sampling
45342-51 · Second procedure: 50%
$75.82
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%).
45342 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45341Sigmoidoscopy ultrasoundEndoscopic ultrasound examination
- Choose 45342 when endoscopic ultrasound guides needle aspiration or biopsy. Choose 45341 for ultrasound examination without guided needle sampling.
- 45331SigmoidoscopyWith biopsy
- 45331 is for sigmoidoscopy with routine mucosal biopsy. 45342 involves ultrasound-guided needle sampling of a target.
- 45392Colonoscopy with EUSWith needle sampling
- 45392 describes ultrasound-guided sampling performed during colonoscopy; 45342 is the sigmoidoscopy approach.
45342 billing questions
How does 45342 differ from 45341?
45342 includes endoscopic ultrasound-guided needle aspiration or biopsy. Use 45341 when ultrasound examination is performed without guided needle sampling.
Can a routine mucosal biopsy support 45342?
No. 45342 describes ultrasound-guided needle sampling; a routine forceps biopsy of the mucosal lining is a different service.
Should the diagnostic sigmoidoscopy be billed separately?
The code includes the sigmoidoscopic examination needed to perform the ultrasound-guided sampling. Do not separately report a diagnostic examination for that same service.
What documentation supports reporting 45342?
Document the lesion or target, the endoscopic ultrasound findings, and the needle aspiration or biopsy performed under ultrasound guidance.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 45342.
What happens when related endoscopies are performed together?
CMS endoscopy family pricing applies when related endoscopies are performed together. The service has a 0-day global period, so same-day preoperative and postoperative care is included.
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
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