CPT code 45346: Flexible sigmoidoscopy, lesion ablation2026 Medicare rate & RVUs
Reports flexible sigmoidoscopy treatment that ablates a colorectal tumor, polyp, or other lesion that is not suited to standard endoscopic removal.
Medicare pays $2,492.38 for 45346 nationally in the office and $143.29 in a hospital or facility. Local office rates run $2,149.95–$3,553.33.
Medicare rate · 45346
Flexible sigmoidoscopy, lesion ablation
- Work RVUs
- 2.74
- Total RVUs
- 74.62
- Global days
- 000
National rate · 2026
$2,492.38
Office setting, before claim adjustments.
See every locality for 45346 →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 45346 covers
During flexible sigmoidoscopy, the clinician examines the rectum and sigmoid colon and destroys a tumor, polyp, or other lesion endoscopically, such as with laser or electrosurgical energy. This treatment is selected when the lesion is not amenable to removal with hot biopsy forceps, bipolar cautery, or a snare. Gastroenterologists and colorectal surgeons commonly perform it in an endoscopy unit or procedure room.
Report the service when the operative note supports ablation rather than biopsy, snare removal, or another therapeutic technique. Document the lesion treated, its location, the ablation method, and why the chosen approach was used. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Do not append modifier 50; this flexible endoscopic treatment is not a bilateral procedure. CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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 45346 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
$2149.95 to $3553.33
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $2,188.76 | $133.31 |
| Alaska | $2,688.35 | $186.58 |
| Arizona | $2,416.67 | $140.40 |
| Arkansas | $2,149.95 | $132.08 |
| Atlanta, GA | $2,533.16 | $146.49 |
| Austin, TX | $2,629.85 | $144.52 |
| Bakersfield, CA | $2,719.07 | $144.47 |
| Baltimore area, MD | $2,670.96 | $150.40 |
| Beaumont, TX | $2,276.51 | $138.85 |
| Brazoria, TX | $2,469.10 | $141.16 |
| Chicago, IL | $2,519.67 | $158.84 |
| Chico, CA | $2,718.05 | $143.46 |
| Colorado | $2,643.91 | $144.49 |
| Connecticut | $2,680.58 | $150.62 |
| Dallas, TX | $2,482.03 | $142.34 |
| Delaware | $2,463.01 | $142.12 |
| Detroit, MI | $2,416.53 | $149.67 |
| East St. Louis, IL | $2,312.73 | $151.57 |
| El Centro, CA | $2,718.11 | $143.51 |
| Fort Lauderdale, FL | $2,532.61 | $152.99 |
| Fort Worth, TX | $2,458.28 | $142.08 |
| Fresno, CA | $2,718.05 | $143.46 |
| Galveston, TX | $2,474.43 | $141.79 |
| Hanford, CA | $2,718.05 | $143.46 |
| Hawaii, Guam, HI | $2,814.96 | $144.05 |
| Houston, TX | $2,480.65 | $148.01 |
| Idaho | $2,295.23 | $134.07 |
| Indiana | $2,312.10 | $134.50 |
| Iowa | $2,282.42 | $133.01 |
| Kansas | $2,257.35 | $133.78 |
| Kentucky | $2,226.18 | $137.84 |
| King County, WA | $3,037.29 | $154.96 |
| Los Angeles, CA | $2,929.59 | $150.62 |
| Madera, CA | $2,718.05 | $143.46 |
| Manhattan, NY | $2,891.99 | $162.35 |
| Marin County, CA | $3,474.62 | $162.41 |
| Merced, CA | $2,718.05 | $143.46 |
| Metropolitan Boston, MA | $2,958.44 | $153.63 |
| Metropolitan Kansas City, MO | $2,346.35 | $140.56 |
| Metropolitan Philadelphia, PA | $2,594.18 | $148.79 |
| Metropolitan St. Louis, MO | $2,377.70 | $141.37 |
| Miami, FL | $2,607.71 | $162.31 |
| Minnesota | $2,553.68 | $136.47 |
| Mississippi | $2,157.27 | $134.71 |
| Modesto, CA | $2,718.05 | $143.46 |
| Montana | $2,492.35 | $143.27 |
| Napa, CA | $3,252.41 | $156.32 |
| Nebraska | $2,301.32 | $133.11 |
| Nevada | $2,492.87 | $141.43 |
| New Hampshire | $2,588.93 | $143.53 |
| New Mexico | $2,296.33 | $142.22 |
| New Orleans, LA | $2,352.94 | $142.45 |
| North Carolina | $2,328.18 | $136.48 |
| North Dakota | $2,485.63 | $136.54 |
| Northern New Jersey | $2,881.23 | $156.29 |
| NYC suburbs and Long Island, NY | $2,959.58 | $166.52 |
| Ohio | $2,284.58 | $139.86 |
| Oklahoma | $2,234.17 | $136.43 |
| Oxnard, CA | $2,925.55 | $148.93 |
| Portland, OR | $2,756.17 | $146.33 |
| Poughkeepsie and northern NYC suburbs, NY | $2,725.88 | $153.63 |
| Puerto Rico | $2,518.49 | $143.56 |
| Queens, NY | $2,938.14 | $161.52 |
| Redding, CA | $2,718.05 | $143.46 |
| Rest of California | $2,718.05 | $143.46 |
| Rest of Florida | $2,392.95 | $147.22 |
| Rest of Georgia | $2,236.49 | $141.11 |
| Rest of Illinois | $2,290.88 | $146.17 |
| Rest of Louisiana | $2,217.11 | $138.17 |
| Rest of Maine | $2,296.92 | $135.76 |
| Rest of Maryland | $2,521.03 | $143.76 |
| Rest of Massachusetts | $2,618.18 | $144.59 |
| Rest of Michigan | $2,285.95 | $141.24 |
| Rest of Missouri | $2,162.33 | $137.42 |
| Rest of New Jersey | $2,716.97 | $151.77 |
| Rest of New York | $2,369.53 | $137.90 |
| Rest of Oregon | $2,479.44 | $139.76 |
| Rest of Pennsylvania | $2,295.81 | $139.35 |
| Rest of Texas | $2,369.41 | $140.13 |
| Rest of Washington | $2,617.49 | $143.91 |
| Rhode Island | $2,571.74 | $145.14 |
| Riverside, CA | $2,721.75 | $147.15 |
| Sacramento, CA | $2,879.89 | $147.90 |
| Salinas, CA | $2,869.87 | $147.28 |
| San Benito County, CA | $3,553.33 | $165.95 |
| San Diego, CA | $2,958.26 | $148.76 |
| San Francisco, CA | $3,474.23 | $162.02 |
| San Luis Obispo, CA | $2,820.80 | $145.19 |
| Santa Clara County, CA | $3,551.75 | $164.37 |
| Santa Cruz, CA | $3,002.77 | $148.63 |
| Santa Maria, CA | $2,886.33 | $147.29 |
| Santa Rosa, CA | $3,034.66 | $149.98 |
| South Carolina | $2,309.07 | $138.51 |
| South Dakota | $2,484.83 | $135.75 |
| Southern Maine, ME | $2,466.68 | $138.74 |
| Stockton, CA | $2,718.05 | $143.46 |
| Suburban Chicago, IL | $2,566.30 | $153.79 |
| Tennessee | $2,269.67 | $134.35 |
| Utah | $2,347.85 | $139.71 |
| Vallejo, CA | $3,251.86 | $155.76 |
| Vermont | $2,462.87 | $137.28 |
| Virgin Islands, VI | $2,518.49 | $143.56 |
| Virginia | $2,448.41 | $139.26 |
| Visalia, CA | $2,718.05 | $143.46 |
| Washington, DC area | $2,923.93 | $156.71 |
| West Virginia | $2,184.25 | $142.89 |
| Wisconsin | $2,384.16 | $133.73 |
| Wyoming | $2,489.42 | $140.34 |
| Yuba City, CA | $2,718.05 | $143.46 |
45346 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.
$2,149.95
$3,135.69
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 | $2,688.35 | 1 |
| AL | $2,188.76 | 1 |
| AR | $2,149.95 | 1 |
| AZ | $2,416.67 | 1 |
| CA | $2,718.05–$3,553.33 | 29 |
| CO | $2,643.91 | 1 |
| CT | $2,680.58 | 1 |
| DC | $2,923.93 | 1 |
| DE | $2,463.01 | 1 |
| FL | $2,392.95–$2,607.71 | 3 |
| GA | $2,236.49–$2,533.16 | 2 |
| GU | $2,814.96 | 1 |
| HI | $2,814.96 | 1 |
| IA | $2,282.42 | 1 |
| ID | $2,295.23 | 1 |
| IL | $2,290.88–$2,566.30 | 4 |
| IN | $2,312.10 | 1 |
| KS | $2,257.35 | 1 |
| KY | $2,226.18 | 1 |
| LA | $2,217.11–$2,352.94 | 2 |
| MA | $2,618.18–$2,958.44 | 2 |
| MD | $2,521.03–$2,923.93 | 3 |
| ME | $2,296.92–$2,466.68 | 2 |
| MI | $2,285.95–$2,416.53 | 2 |
| MN | $2,553.68 | 1 |
| MO | $2,162.33–$2,377.70 | 3 |
| MS | $2,157.27 | 1 |
| MT | $2,492.35 | 1 |
| NC | $2,328.18 | 1 |
| ND | $2,485.63 | 1 |
| NE | $2,301.32 | 1 |
| NH | $2,588.93 | 1 |
| NJ | $2,716.97–$2,881.23 | 2 |
| NM | $2,296.33 | 1 |
| NV | $2,492.87 | 1 |
| NY | $2,369.53–$2,959.58 | 5 |
| OH | $2,284.58 | 1 |
| OK | $2,234.17 | 1 |
| OR | $2,479.44–$2,756.17 | 2 |
| PA | $2,295.81–$2,594.18 | 2 |
| PR | $2,518.49 | 1 |
| RI | $2,571.74 | 1 |
| SC | $2,309.07 | 1 |
| SD | $2,484.83 | 1 |
| TN | $2,269.67 | 1 |
| TX | $2,276.51–$2,629.85 | 8 |
| UT | $2,347.85 | 1 |
| VA | $2,448.41–$2,923.93 | 2 |
| VI | $2,518.49 | 1 |
| VT | $2,462.87 | 1 |
| WA | $2,617.49–$3,037.29 | 2 |
| WI | $2,384.16 | 1 |
| WV | $2,184.25 | 1 |
| WY | $2,489.42 | 1 |
How the 45346 rate is calculated
Each of 45346’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 · 45346
RVUs × geographic indexes × conversion factor
Work2.74
2.74 RVUs× 1.000 GPCI
Practice expense71.54
71.54 RVUs× 1.000 GPCI
Malpractice0.34
0.34 RVUs× 1.000 GPCI
Adjusted RVUs
74.6200
Conversion factor
$33.4009
Medicare rate
$2,492.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45346
The CMS indicators that decide how 45346 is paid alongside other services.
CMS payment indicators · 45346
Flexible sigmoidoscopy, lesion ablation
| 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
45346 without 51 · national office
$2,492.38
Flexible sigmoidoscopy, lesion ablation
45346-51 · Second procedure: 50%
$1,246.19
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%).
45346 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 45333Flexible sigmoidoscopyHot biopsy forceps removal
- 45333 is for lesion removal using hot biopsy forceps or bipolar cautery. Choose 45346 when the lesion is ablated rather than removed and is not amenable to those methods.
- 45338Flexible sigmoidoscopySnare lesion removal
- 45338 reports lesion removal by snare. Choose 45346 when the treatment is ablation, not snare excision.
- 45330Flexible sigmoidoscopyDiagnostic
- 45330 is diagnostic flexible sigmoidoscopy without lesion ablation. When ablation is performed, the therapeutic service distinguishes 45346.
- 45349Endoscopic mucosal resectionFlexible sigmoidoscopy
- 45349 reports endoscopic mucosal resection. It differs from 45346, which describes ablation of a lesion rather than mucosal resection.
45346 billing questions
When should this code be chosen instead of a removal code?
Use it when the lesion is ablated rather than removed and is not amenable to hot biopsy forceps, bipolar cautery, or snare removal. The operative note should identify the technique and lesion.
How does this differ from diagnostic flexible sigmoidoscopy?
A diagnostic examination reports the inspection when no ablation is performed. When a lesion is treated by ablation during the examination, report the therapeutic service instead of treating the encounter as diagnostic only.
Can biopsy or another endoscopy be reported on the same date?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Documentation should distinguish any separately performed service; do not report a diagnostic examination merely for the inspection integral to the therapeutic procedure.
Should modifier 50 be appended?
No. This is not a bilateral procedure, so modifier 50 is inappropriate.
What global-period and surgical-assistance rules apply?
The service has a 0-day global period, with same-day preoperative and postoperative care included. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery reporting are not permitted.
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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