CPT code 45349: Endoscopic mucosal resection, flexible sigmoidoscopy2026 Medicare rate & RVUs in California
Reports endoscopic mucosal resection of a lesion reached by flexible sigmoidoscopy, typically when a colorectal lesion is lifted and removed endoscopically.
CMS doesn’t publish an office rate for 45349 in California.
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 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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $177.02 |
| Chico, CA | Unavailable | $175.84 |
| El Centro, CA | Unavailable | $175.91 |
| Fresno, CA | Unavailable | $175.84 |
| Hanford, CA | Unavailable | $175.84 |
| Los Angeles, CA | Unavailable | $184.42 |
| Madera, CA | Unavailable | $175.84 |
| Marin County, CA | Unavailable | $198.77 |
| Merced, CA | Unavailable | $175.84 |
| Modesto, CA | Unavailable | $175.84 |
| Napa, CA | Unavailable | $191.35 |
| Oxnard, CA | Unavailable | $182.34 |
| Redding, CA | Unavailable | $175.84 |
| Rest of California | Unavailable | $175.84 |
| Riverside, CA | Unavailable | $180.09 |
| Sacramento, CA | Unavailable | $181.22 |
| Salinas, CA | Unavailable | $180.46 |
| San Benito County, CA | Unavailable | $203.02 |
| San Diego, CA | Unavailable | $182.19 |
| San Francisco, CA | Unavailable | $198.33 |
| San Luis Obispo, CA | Unavailable | $177.90 |
| Santa Clara County, CA | Unavailable | $201.21 |
| Santa Cruz, CA | Unavailable | $181.99 |
| Santa Maria, CA | Unavailable | $180.45 |
| Santa Rosa, CA | Unavailable | $183.64 |
| Stockton, CA | Unavailable | $175.84 |
| Vallejo, CA | Unavailable | $190.71 |
| Visalia, CA | Unavailable | $175.84 |
| Yuba City, CA | Unavailable | $175.84 |
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
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
| 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
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%).
45349 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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