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CPT code 45346: Flexible sigmoidoscopy, lesion ablation2026 Medicare rate & RVUs in West Virginia

Reports flexible sigmoidoscopy treatment that ablates a colorectal tumor, polyp, or other lesion that is not suited to standard endoscopic removal.

CMS RVU26DEffective Oct 1, 2026One payment locality984 Medicare services in 2024

In West Virginia, Medicare pays $2,184.25 for 45346 in the office and $142.89 when it’s performed in a hospital or facility.

$2,184.25Office (non-facility)
$142.89Hospital or facility
−12.4%vs the national office rate ($2,492.38)

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.

We’ll open 45346 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 45346 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 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 West Virginia 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. West Virginia pays $2,184.25. The RVUs are the same everywhere; the geographic indexes change the dollars.

45346 in West Virginia vs other payment areas
  1. West Virginia · this page$2,184.25
  2. Los Angeles, CA · California$2,929.59+$745.34
  3. Washington, DC area · District of Columbia$2,923.93+$739.68
  4. Miami, FL · Florida$2,607.71+$423.46
  5. Chicago, IL · Illinois$2,519.67+$335.42
  6. Manhattan, NY · New York$2,891.99+$707.74
  7. Alaska · Alaska$2,688.35+$504.10

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

Every other payment area

45346 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$2,188.76$133.31
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

45346 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.

$2,149.95

$3,135.69

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

View every state and territory as a table
45346 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,688.351
AL$2,188.761
AR$2,149.951
AZ$2,416.671
CA$2,718.05–$3,553.3329
CO$2,643.911
CT$2,680.581
DC$2,923.931
DE$2,463.011
FL$2,392.95–$2,607.713
GA$2,236.49–$2,533.162
GU$2,814.961
HI$2,814.961
IA$2,282.421
ID$2,295.231
IL$2,290.88–$2,566.304
IN$2,312.101
KS$2,257.351
KY$2,226.181
LA$2,217.11–$2,352.942
MA$2,618.18–$2,958.442
MD$2,521.03–$2,923.933
ME$2,296.92–$2,466.682
MI$2,285.95–$2,416.532
MN$2,553.681
MO$2,162.33–$2,377.703
MS$2,157.271
MT$2,492.351
NC$2,328.181
ND$2,485.631
NE$2,301.321
NH$2,588.931
NJ$2,716.97–$2,881.232
NM$2,296.331
NV$2,492.871
NY$2,369.53–$2,959.585
OH$2,284.581
OK$2,234.171
OR$2,479.44–$2,756.172
PA$2,295.81–$2,594.182
PR$2,518.491
RI$2,571.741
SC$2,309.071
SD$2,484.831
TN$2,269.671
TX$2,276.51–$2,629.858
UT$2,347.851
VA$2,448.41–$2,923.932
VI$2,518.491
VT$2,462.871
WA$2,617.49–$3,037.292
WI$2,384.161
WV$2,184.251
WY$2,489.421

See 45346 in every payment locality

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

Office or facility?

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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 45346 in West Virginia
ComponentRVULocality factorAdjusted
Physician work2.74× 1.0002.7400
Practice expense71.54× 0.86962.1683
Malpractice0.34× 1.4310.4865
Total RVUs65.3948
Conversion factor× 33.4009

Office rate, West Virginia$2184.25

Office: (2.74 × 1 + 71.54 × 0.869 + 0.34 × 1.431) × $33.4009 = $2184.25

Facility: (2.74 × 1 + 1.21 × 0.869 + 0.34 × 1.431) × $33.4009 = $142.89

Open 45346 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 45346

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

Codes related to 45346
CodeHow it relatesOffice range, West Virginia
Used instead
45330Flexible sigmoidoscopy, diagnosticDiagnostic flexible sigmoidoscopy when no lesion ablation or other therapeutic service is performed.$192.76
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when tissue sampling, rather than ablation, is performed.$288.16
45333Flexible sigmoidoscopy, hot biopsy forceps removalFlexible sigmoidoscopy with lesion removal by hot biopsy forceps or bipolar cautery.$330.60
45338Flexible sigmoidoscopy, snare lesion removalFlexible sigmoidoscopy with lesion removal by snare technique.$304.57
45334Flexible sigmoidoscopy, endoscopic bleeding controlFlexible sigmoidoscopy to control bleeding, rather than ablate a lesion.$485.49
45349Endoscopic mucosal resection, flexible sigmoidoscopyFlexible sigmoidoscopy with endoscopic mucosal resection rather than lesion ablation.No office rate

How 45346 has changed in West Virginia

45346 · Office / nonfacility

$2184.25

Effective 2026-10-01

The base rate is $370.73 higher than on 2025-10-01, moving from $1813.52 to $2184.25 (20.4%).

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

    $1813.52changed to$2184.25

    • 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
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1964.98changed to$1813.52

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 64.68 changed to 61.24

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1932.91changed to$1964.98

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $2042.42changed to$1932.91

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 66.30 changed to 64.68
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $2179.87changed to$2042.42

    • 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
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $2411.88changed to$2179.87

    • 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.

  7. January 1, 2021

    RVU21A

    $2439.49changed to$2411.88

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 75.13 changed to 76.84
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $2564.84changed to$2439.49

    • 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
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $2719.07changed to$2564.84

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 84.28 changed to 79.19

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $2652.08changed to$2719.07

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 83.35 changed to 84.28
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $2671.00changed to$2652.08

    • 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
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    No ratechanged to$2671.00

    Held through RVU16B, RVU16C, RVU16D.

  13. January 1, 2015

    RVU15A

    No ratechanged toNo rate

    Held through RVU15B, RVU15C, RVU15D.

  14. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$2,184.25$142.89RVU26D
2026-07-01$2,184.25$142.89RVU26C
2026-04-01$2,184.25$142.89RVU26B
2026-01-01$2,184.25$142.89RVU26A
2025-10-01$1,813.52$150.32RVU25D
2025-07-01$1,813.52$150.32RVU25C
2025-04-01$1,813.52$150.32RVU25B
2025-01-01$1,813.52$150.32RVU25A
2024-10-01$1,964.98$154.40RVU24D
2024-07-01$1,964.98$154.40RVU24C
2024-04-01$1,964.98$154.40RVU24B
2024-03-09$1,964.98$154.40RVU24AR
2024-01-01$1,932.91$151.88RVU24A
2023-10-01$2,042.42$155.70RVU23D
2023-07-01$2,042.42$155.70RVU23C
2023-04-01$2,042.42$155.70RVU23B
2023-01-01$2,042.42$155.70RVU23A
2022-10-01$2,179.87$156.95RVU22D
2022-07-01$2,179.87$156.95RVU22C
2022-04-01$2,179.87$156.95RVU22B
2022-01-01$2,179.87$156.95RVU22A
2021-10-01$2,411.88$157.53RVU21D
2021-07-01$2,411.88$157.53RVU21C
2021-04-01$2,411.88$157.53RVU21B
2021-01-01$2,411.88$157.53RVU21A
2020-10-01$2,439.49$161.90RVU20D
2020-07-01$2,439.49$161.90RVU20C
2020-04-01$2,439.49$161.90RVU20B
2020-01-01$2,439.49$161.90RVU20A
2019-10-01$2,564.84$165.66RVU19D
2019-07-01$2,564.84$165.66RVU19C
2019-04-01$2,564.84$165.66RVU19B
2019-01-01$2,564.84$165.66RVU19A
2018-10-01$2,719.07$166.09RVU18D
2018-07-01$2,719.07$166.09RVU18C
2018-04-01$2,719.07$166.09RVU18B
2018-01-01$2,719.07$166.09RVU18AR1
2017-10-01$2,652.08$164.93RVU17D
2017-07-01$2,652.08$164.93RVU17C
2017-04-01$2,652.08$164.93RVU17B
2017-01-01$2,652.08$164.93RVU17A
2016-10-01$2,671.00$168.95RVU16D
2016-07-01$2,671.00$168.95RVU16C
2016-04-01$2,671.00$168.95RVU16B
2016-01-01$2,671.00$168.95RVU16A
2015-10-01Separate payment rules applySeparate payment rules applyRVU15D
2015-07-01Separate payment rules applySeparate payment rules applyRVU15C
2015-04-01Separate payment rules applySeparate payment rules applyRVU15B
2015-01-01Separate payment rules applySeparate payment rules applyRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 45346 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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
RVUs for 45346PPRRVU2026_Oct_nonQPP.csv, line 5,509 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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