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CPT code 45349: Endoscopic mucosal resection, flexible sigmoidoscopy2026 Medicare rate & RVUs

Reports endoscopic mucosal resection of a lesion reached by flexible sigmoidoscopy, typically when a colorectal lesion is lifted and removed endoscopically.

CMS RVU26DEffective Oct 1, 2026109 payment localities780 Medicare services in 2024

Medicare pays $175.35 for 45349 nationally in a facility.

Medicare rate · 45349

Endoscopic mucosal resection, flexible sigmoidoscopy

Office or facility?

Work RVUs
3.43
Total RVUs
5.25
Global days
000

National rate · 2026

$175.35

Facility setting, before claim adjustments.

See every locality for 45349 →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.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 45349 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 45349 covers

A gastroenterologist or colorectal surgeon uses a flexible sigmoidoscope to reach a lesion in the rectum or sigmoid colon and perform endoscopic mucosal resection (EMR). The technique commonly involves lifting the lesion from the underlying wall, often with a submucosal injection, then removing the targeted mucosa with an endoscopic resection instrument. It is performed in an endoscopy setting for lesions selected for endoscopic rather than surgical removal.

Report this code when the documented therapeutic service is EMR during flexible sigmoidoscopy, not merely inspection, biopsy, or routine snare removal. The report should identify the lesion’s location and describe the EMR technique and resection performed. Medicare 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; CMS also does not pay an assistant at surgery, and does not permit co-surgeons or team surgery for this service.

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 45349 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

45349 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$163.73
AlaskaUnavailable$229.89
ArizonaUnavailable$172.00
ArkansasUnavailable$162.30
Atlanta, GAUnavailable$179.08
Austin, TXUnavailable$176.87
Bakersfield, CAUnavailable$177.02
Baltimore area, MDUnavailable$183.76
Beaumont, TXUnavailable$170.13
Brazoria, TXUnavailable$172.98

45349 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
45349 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 45349 rate is calculated

Each of 45349’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 · 45349

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.43

3.43 RVUs× 1.000 GPCI

Practice expense1.43

1.43 RVUs× 1.000 GPCI

Malpractice0.39

0.39 RVUs× 1.000 GPCI

Adjusted RVUs

5.2500

Conversion factor

$33.4009

Medicare rate

$175.35

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 45349

The CMS indicators that decide how 45349 is paid alongside other services.

CMS payment indicators · 45349

Endoscopic mucosal resection, flexible sigmoidoscopy

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

45349 without 51 · national facility

$175.35

Endoscopic mucosal resection, flexible sigmoidoscopy

45349-51 · Second procedure: 50%

$87.68

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

45349 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 45349

    Endoscopic mucosal resection, flexible sigmoidoscopy3.43 wRVU

    Not priced

  • 45333

    Flexible sigmoidoscopy, hot biopsy forceps removal1.51 wRVU

    $368.08

  • 45390

    Colonoscopy, mucosal lesion resection5.89 wRVU

    Not priced

  • 45331

    Sigmoidoscopy, with biopsy1.11 wRVU

    $322.99

How to choose

45333Flexible sigmoidoscopyHot biopsy forceps removal
45333 describes lesion removal by snare technique. Choose 45349 when the documented intervention is EMR.
45390ColonoscopyMucosal lesion resection
Both describe EMR, but 45349 is for flexible sigmoidoscopy and 45390 is for colonoscopy.
45331SigmoidoscopyWith biopsy
45331 is for sigmoidoscopy with biopsy. It does not describe resection of the lesion by EMR.

Codes related to 45349

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

Codes related to 45349
CodeHow it relatesNational office range
Used instead
45390Colonoscopy, mucosal lesion resectionEndoscopic mucosal resection performed through colonoscopy rather than flexible sigmoidoscopy.No office rate
45333Flexible sigmoidoscopy, hot biopsy forceps removalFlexible sigmoidoscopy with snare removal rather than endoscopic mucosal resection.$320.76–$507.37
45331Sigmoidoscopy, with biopsyFlexible sigmoidoscopy with biopsy when tissue sampling, rather than EMR, is performed.$281.06–$449.20
45330Flexible sigmoidoscopy, diagnosticDiagnostic flexible sigmoidoscopy without the EMR service.$187.26–$297.45
45346Flexible sigmoidoscopy, lesion ablationFlexible sigmoidoscopy with ablation rather than endoscopic mucosal resection.$2,149.95–$3,553.33

45349 billing questions

How does this differ from 45333?

Use 45349 for EMR performed through flexible sigmoidoscopy. Code 45333 describes a different lesion-removal technique, snare removal, rather than EMR.

Can diagnostic sigmoidoscopy be reported separately with the EMR?

The inspection that leads to EMR is part of the therapeutic endoscopy. When related endoscopies are performed together, Medicare applies endoscopy family pricing.

What documentation supports reporting 45349?

Document the lesion’s location and the EMR technique and resection performed. The record should distinguish EMR from biopsy, diagnostic examination, or another removal method.

Should modifier 50 be appended for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant surgeon or co-surgeon be billed?

CMS does not pay an assistant at surgery for this service and does not permit co-surgeons or team surgery.

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 45349PPRRVU2026_Oct_nonQPP.csv, line 5,511 (RVU26D)

Open CMS sourceHow we calculate rates

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