CPT code 45346: Flexible sigmoidoscopy, lesion ablation2026 Medicare rate & RVUs in Washington, DC area
Reports flexible sigmoidoscopy treatment that ablates a colorectal tumor, polyp, or other lesion that is not suited to standard endoscopic removal.
In Washington, DC area, Medicare pays $2,923.93 for 45346 in the office and $156.71 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45346 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Washington, DC area compares for 45346
Across 109 of 109 payment localities, the office rate for 45346 runs from $2,149.95 in Arkansas to $3,553.33 in San Benito County, CA. Washington, DC area pays $2,923.93. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$2,923.93
- Los Angeles, CA · California$2,929.59+$5.66
- Miami, FL · Florida$2,607.71−$316.22
- Chicago, IL · Illinois$2,519.67−$404.26
- Manhattan, NY · New York$2,891.99−$31.94
- Alaska · Alaska$2,688.35−$235.58
- Alabama · Alabama$2,188.76−$735.17
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $2,149.95 | $132.08 |
| ArizonaArizona | $2,416.67 | $140.40 |
| Bakersfield, CACalifornia | $2,719.07 | $144.47 |
| Chico, CACalifornia | $2,718.05 | $143.46 |
| El Centro, CACalifornia | $2,718.11 | $143.51 |
| Fresno, CACalifornia | $2,718.05 | $143.46 |
| Hanford, CACalifornia | $2,718.05 | $143.46 |
| Madera, CACalifornia | $2,718.05 | $143.46 |
| Merced, CACalifornia | $2,718.05 | $143.46 |
| Modesto, CACalifornia | $2,718.05 | $143.46 |
| Napa, CACalifornia | $3,252.41 | $156.32 |
| Oxnard, CACalifornia | $2,925.55 | $148.93 |
| Redding, CACalifornia | $2,718.05 | $143.46 |
| Rest of CaliforniaCalifornia | $2,718.05 | $143.46 |
| Riverside, CACalifornia | $2,721.75 | $147.15 |
| Sacramento, CACalifornia | $2,879.89 | $147.90 |
| Salinas, CACalifornia | $2,869.87 | $147.28 |
| San Diego, CACalifornia | $2,958.26 | $148.76 |
| Marin County, CACalifornia | $3,474.62 | $162.41 |
| San Francisco, CACalifornia | $3,474.23 | $162.02 |
| San Benito County, CACalifornia | $3,553.33 | $165.95 |
| Santa Clara County, CACalifornia | $3,551.75 | $164.37 |
| San Luis Obispo, CACalifornia | $2,820.80 | $145.19 |
| Santa Cruz, CACalifornia | $3,002.77 | $148.63 |
| Santa Maria, CACalifornia | $2,886.33 | $147.29 |
| Santa Rosa, CACalifornia | $3,034.66 | $149.98 |
| Stockton, CACalifornia | $2,718.05 | $143.46 |
| Vallejo, CACalifornia | $3,251.86 | $155.76 |
| Visalia, CACalifornia | $2,718.05 | $143.46 |
| Yuba City, CACalifornia | $2,718.05 | $143.46 |
| ColoradoColorado | $2,643.91 | $144.49 |
| ConnecticutConnecticut | $2,680.58 | $150.62 |
| DelawareDelaware | $2,463.01 | $142.12 |
| Fort Lauderdale, FLFlorida | $2,532.61 | $152.99 |
| Rest of FloridaFlorida | $2,392.95 | $147.22 |
| Atlanta, GAGeorgia | $2,533.16 | $146.49 |
| Rest of GeorgiaGeorgia | $2,236.49 | $141.11 |
| Hawaii, Guam, HIHawaii | $2,814.96 | $144.05 |
| IowaIowa | $2,282.42 | $133.01 |
| IdahoIdaho | $2,295.23 | $134.07 |
| East St. Louis, ILIllinois | $2,312.73 | $151.57 |
| Rest of IllinoisIllinois | $2,290.88 | $146.17 |
| Suburban Chicago, ILIllinois | $2,566.30 | $153.79 |
| IndianaIndiana | $2,312.10 | $134.50 |
| KansasKansas | $2,257.35 | $133.78 |
| KentuckyKentucky | $2,226.18 | $137.84 |
| New Orleans, LALouisiana | $2,352.94 | $142.45 |
| Rest of LouisianaLouisiana | $2,217.11 | $138.17 |
| Metropolitan Boston, MAMassachusetts | $2,958.44 | $153.63 |
| Rest of MassachusettsMassachusetts | $2,618.18 | $144.59 |
| Baltimore area, MDMaryland | $2,670.96 | $150.40 |
| Rest of MarylandMaryland | $2,521.03 | $143.76 |
| Rest of MaineMaine | $2,296.92 | $135.76 |
| Southern Maine, MEMaine | $2,466.68 | $138.74 |
| Detroit, MIMichigan | $2,416.53 | $149.67 |
| Rest of MichiganMichigan | $2,285.95 | $141.24 |
| MinnesotaMinnesota | $2,553.68 | $136.47 |
| Metropolitan Kansas City, MOMissouri | $2,346.35 | $140.56 |
| Metropolitan St. Louis, MOMissouri | $2,377.70 | $141.37 |
| Rest of MissouriMissouri | $2,162.33 | $137.42 |
| MississippiMississippi | $2,157.27 | $134.71 |
| MontanaMontana | $2,492.35 | $143.27 |
| North CarolinaNorth Carolina | $2,328.18 | $136.48 |
| North DakotaNorth Dakota | $2,485.63 | $136.54 |
| NebraskaNebraska | $2,301.32 | $133.11 |
| New HampshireNew Hampshire | $2,588.93 | $143.53 |
| Northern New JerseyNew Jersey | $2,881.23 | $156.29 |
| Rest of New JerseyNew Jersey | $2,716.97 | $151.77 |
| New MexicoNew Mexico | $2,296.33 | $142.22 |
| NevadaNevada | $2,492.87 | $141.43 |
| NYC suburbs and Long Island, NYNew York | $2,959.58 | $166.52 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $2,725.88 | $153.63 |
| Queens, NYNew York | $2,938.14 | $161.52 |
| Rest of New YorkNew York | $2,369.53 | $137.90 |
| OhioOhio | $2,284.58 | $139.86 |
| OklahomaOklahoma | $2,234.17 | $136.43 |
| Portland, OROregon | $2,756.17 | $146.33 |
| Rest of OregonOregon | $2,479.44 | $139.76 |
| Metropolitan Philadelphia, PAPennsylvania | $2,594.18 | $148.79 |
| Rest of PennsylvaniaPennsylvania | $2,295.81 | $139.35 |
| Puerto RicoPuerto Rico | $2,518.49 | $143.56 |
| Rhode IslandRhode Island | $2,571.74 | $145.14 |
| South CarolinaSouth Carolina | $2,309.07 | $138.51 |
| South DakotaSouth Dakota | $2,484.83 | $135.75 |
| TennesseeTennessee | $2,269.67 | $134.35 |
| Austin, TXTexas | $2,629.85 | $144.52 |
| Beaumont, TXTexas | $2,276.51 | $138.85 |
| Brazoria, TXTexas | $2,469.10 | $141.16 |
| Dallas, TXTexas | $2,482.03 | $142.34 |
| Fort Worth, TXTexas | $2,458.28 | $142.08 |
| Galveston, TXTexas | $2,474.43 | $141.79 |
| Houston, TXTexas | $2,480.65 | $148.01 |
| Rest of TexasTexas | $2,369.41 | $140.13 |
| UtahUtah | $2,347.85 | $139.71 |
| VirginiaVirginia | $2,448.41 | $139.26 |
| Virgin Islands, VIUnited States Virgin Islands | $2,518.49 | $143.56 |
| VermontVermont | $2,462.87 | $137.28 |
| Rest of WashingtonWashington | $2,617.49 | $143.91 |
| King County, WAWashington | $3,037.29 | $154.96 |
| WisconsinWisconsin | $2,384.16 | $133.73 |
| West VirginiaWest Virginia | $2,184.25 | $142.89 |
| WyomingWyoming | $2,489.42 | $140.34 |
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.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,509
- Code
- 45346
- Physician work
- 2.74
- Practice expense
- 71.54
- Malpractice
- 0.34
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.74 | × 1.054 | 2.8880 |
| Practice expense | 71.54 | × 1.178 | 84.2741 |
| Malpractice | 0.34 | × 1.113 | 0.3784 |
| Total RVUs | 87.5405 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$2923.93
Office: (2.74 × 1.054 + 71.54 × 1.178 + 0.34 × 1.113) × $33.4009 = $2923.93
Facility: (2.74 × 1.054 + 1.21 × 1.178 + 0.34 × 1.113) × $33.4009 = $156.71
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%).
How 45346 has changed in Washington, DC area
45346 · Office / nonfacility
$2923.93
Effective 2026-10-01
The base rate is $453.40 higher than on 2025-10-01, moving from $2470.53 to $2923.93 (18.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$2470.53changed to$2923.93
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.81 changed to 2.74
- Practice expense RVU 61.24 changed to 71.54
- Malpractice RVU 0.35 changed to 0.34
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$2678.90changed to$2470.53
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 64.68 changed to 61.24
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$2635.17changed to$2678.90
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$2842.68changed to$2635.17
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 66.30 changed to 64.68
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$3097.71changed to$2842.68
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 69.68 changed to 66.30
- Malpractice RVU 0.33 changed to 0.35
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$3431.74changed to$3097.71
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 76.84 changed to 69.68
- Malpractice RVU 0.32 changed to 0.33
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$3431.76changed to$3431.74
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 75.13 changed to 76.84
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$3562.09changed to$3431.76
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 79.19 changed to 75.13
- Malpractice RVU 0.38 changed to 0.32
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$3778.99changed to$3562.09
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 84.28 changed to 79.19
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$3727.57changed to$3778.99
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 83.35 changed to 84.28
- Work GPCI 1.048 changed to 1.045
- Malpractice GPCI 1.271 changed to 1.261
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$3801.13changed to$3727.57
- Conversion factor 35.8043 changed to 35.8887
- Work RVU 2.91 changed to 2.81
- Practice expense RVU 85.14 changed to 83.35
- Malpractice RVU 0.40 changed to 0.38
- Work GPCI 1.051 changed to 1.048
- Malpractice GPCI 1.280 changed to 1.271
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$3801.13
Held through RVU16B, RVU16C, RVU16D.
January 1, 2015
RVU15A
No ratechanged toNo rate
Held through RVU15B, RVU15C, RVU15D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $2,923.93 | $156.71 | RVU26D |
| 2026-07-01 | $2,923.93 | $156.71 | RVU26C |
| 2026-04-01 | $2,923.93 | $156.71 | RVU26B |
| 2026-01-01 | $2,923.93 | $156.71 | RVU26A |
| 2025-10-01 | $2,470.53 | $170.60 | RVU25D |
| 2025-07-01 | $2,470.53 | $170.60 | RVU25C |
| 2025-04-01 | $2,470.53 | $170.60 | RVU25B |
| 2025-01-01 | $2,470.53 | $170.60 | RVU25A |
| 2024-10-01 | $2,678.90 | $175.17 | RVU24D |
| 2024-07-01 | $2,678.90 | $175.17 | RVU24C |
| 2024-04-01 | $2,678.90 | $175.17 | RVU24B |
| 2024-03-09 | $2,678.90 | $175.17 | RVU24AR |
| 2024-01-01 | $2,635.17 | $172.31 | RVU24A |
| 2023-10-01 | $2,842.68 | $179.33 | RVU23D |
| 2023-07-01 | $2,842.68 | $179.33 | RVU23C |
| 2023-04-01 | $2,842.68 | $179.33 | RVU23B |
| 2023-01-01 | $2,842.68 | $179.33 | RVU23A |
| 2022-10-01 | $3,097.71 | $183.57 | RVU22D |
| 2022-07-01 | $3,097.71 | $183.57 | RVU22C |
| 2022-04-01 | $3,097.71 | $183.57 | RVU22B |
| 2022-01-01 | $3,097.71 | $183.57 | RVU22A |
| 2021-10-01 | $3,431.74 | $184.21 | RVU21D |
| 2021-07-01 | $3,431.74 | $184.21 | RVU21C |
| 2021-04-01 | $3,431.74 | $184.21 | RVU21B |
| 2021-01-01 | $3,431.74 | $184.21 | RVU21A |
| 2020-10-01 | $3,431.76 | $186.79 | RVU20D |
| 2020-07-01 | $3,431.76 | $186.79 | RVU20C |
| 2020-04-01 | $3,431.76 | $186.79 | RVU20B |
| 2020-01-01 | $3,431.76 | $186.79 | RVU20A |
| 2019-10-01 | $3,562.09 | $188.67 | RVU19D |
| 2019-07-01 | $3,562.09 | $188.67 | RVU19C |
| 2019-04-01 | $3,562.09 | $188.67 | RVU19B |
| 2019-01-01 | $3,562.09 | $188.67 | RVU19A |
| 2018-10-01 | $3,778.99 | $189.33 | RVU18D |
| 2018-07-01 | $3,778.99 | $189.33 | RVU18C |
| 2018-04-01 | $3,778.99 | $189.33 | RVU18B |
| 2018-01-01 | $3,778.99 | $189.33 | RVU18AR1 |
| 2017-10-01 | $3,727.57 | $189.19 | RVU17D |
| 2017-07-01 | $3,727.57 | $189.19 | RVU17C |
| 2017-04-01 | $3,727.57 | $189.19 | RVU17B |
| 2017-01-01 | $3,727.57 | $189.19 | RVU17A |
| 2016-10-01 | $3,801.13 | $194.71 | RVU16D |
| 2016-07-01 | $3,801.13 | $194.71 | RVU16C |
| 2016-04-01 | $3,801.13 | $194.71 | RVU16B |
| 2016-01-01 | $3,801.13 | $194.71 | RVU16A |
| 2015-10-01 | Separate payment rules apply | Separate payment rules apply | RVU15D |
| 2015-07-01 | Separate payment rules apply | Separate payment rules apply | RVU15C |
| 2015-04-01 | Separate payment rules apply | Separate payment rules apply | RVU15B |
| 2015-01-01 | Separate payment rules apply | Separate payment rules apply | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
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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