CPT code 45350: Sigmoidoscopy, endoscopic band ligation2026 Medicare rate & RVUs
Reports flexible sigmoidoscopy used to place bands on target tissue, commonly internal hemorrhoids, during endoscopic treatment of the rectum or distal colon.
Medicare pays $743.50 for 45350 nationally in the office and $91.85 in a hospital or facility. Local office rates run $643.98–$1,047.59.
Medicare rate · 45350
Sigmoidoscopy, endoscopic band ligation
- Work RVUs
- 1.64
- Total RVUs
- 22.26
- Global days
- 000
National rate · 2026
$743.50
Office setting, before claim adjustments.
See every locality for 45350 →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 45350 covers
A clinician advances a flexible sigmoidoscope to examine the rectum and distal colon, then applies bands to selected tissue. A common use is endoscopic treatment of internal hemorrhoids. Gastroenterologists and colorectal surgeons typically perform the procedure in an office-based endoscopy suite or hospital outpatient department. The scope examination and band placement are reported together as the therapeutic service.
Choose this code when the documented procedure includes endoscopic band ligation, rather than diagnostic inspection alone or treatment by a different method. The report should identify the indication, endoscopic findings, target tissue, and treatment performed. CMS 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 does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 45350 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
$643.98 to $1047.59
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $655.25 | $85.05 |
| Alaska | $812.05 | $118.05 |
| Arizona | $721.36 | $89.91 |
| Arkansas | $643.98 | $84.21 |
| Atlanta, GA | $755.99 | $93.91 |
| Austin, TX | $782.35 | $92.91 |
| Bakersfield, CA | $807.25 | $93.04 |
| Baltimore area, MD | $795.81 | $96.59 |
| Beaumont, TX | $681.65 | $88.65 |
| Brazoria, TX | $736.26 | $90.48 |
| Chicago, IL | $756.38 | $101.47 |
| Chico, CA | $806.63 | $92.41 |
| Colorado | $786.25 | $92.90 |
| Connecticut | $798.56 | $96.74 |
| Dallas, TX | $740.27 | $91.23 |
| Delaware | $734.89 | $91.06 |
| Detroit, MI | $724.46 | $95.61 |
| East St. Louis, IL | $696.08 | $96.56 |
| El Centro, CA | $806.66 | $92.45 |
| Fort Lauderdale, FL | $758.03 | $97.91 |
| Fort Worth, TX | $733.55 | $91.02 |
| Fresno, CA | $806.63 | $92.41 |
| Galveston, TX | $737.96 | $90.87 |
| Hanford, CA | $806.63 | $92.41 |
| Hawaii, Guam, HI | $833.95 | $93.02 |
| Houston, TX | $741.81 | $94.72 |
| Idaho | $685.27 | $85.75 |
| Indiana | $690.13 | $86.05 |
| Iowa | $681.33 | $85.07 |
| Kansas | $674.58 | $85.49 |
| Kentucky | $667.24 | $87.92 |
| King County, WA | $899.71 | $100.13 |
| Los Angeles, CA | $868.15 | $97.24 |
| Madera, CA | $806.63 | $92.41 |
| Manhattan, NY | $861.56 | $104.34 |
| Marin County, CA | $1,024.42 | $105.59 |
| Merced, CA | $806.63 | $92.41 |
| Metropolitan Boston, MA | $877.23 | $99.16 |
| Metropolitan Kansas City, MO | $701.76 | $89.86 |
| Metropolitan Philadelphia, PA | $773.79 | $95.42 |
| Metropolitan St. Louis, MO | $710.80 | $90.42 |
| Miami, FL | $782.18 | $103.81 |
| Minnesota | $758.34 | $87.79 |
| Mississippi | $646.92 | $85.84 |
| Modesto, CA | $806.63 | $92.41 |
| Montana | $743.49 | $91.84 |
| Napa, CA | $960.29 | $101.41 |
| Nebraska | $686.65 | $85.17 |
| Nevada | $743.01 | $90.71 |
| New Hampshire | $770.58 | $92.21 |
| New Mexico | $688.33 | $90.77 |
| New Orleans, LA | $704.24 | $91.03 |
| North Carolina | $695.30 | $87.31 |
| North Dakota | $739.34 | $87.69 |
| Northern New Jersey | $856.51 | $100.59 |
| NYC suburbs and Long Island, NY | $881.86 | $107.05 |
| Ohio | $684.25 | $89.29 |
| Oklahoma | $669.00 | $87.07 |
| Oxnard, CA | $866.47 | $96.21 |
| Portland, OR | $818.25 | $94.27 |
| Poughkeepsie and northern NYC suburbs, NY | $812.20 | $98.65 |
| Puerto Rico | $750.90 | $92.08 |
| Queens, NY | $874.18 | $103.93 |
| Redding, CA | $806.63 | $92.41 |
| Rest of California | $806.63 | $92.41 |
| Rest of Florida | $717.04 | $94.06 |
| Rest of Georgia | $671.23 | $89.95 |
| Rest of Illinois | $688.14 | $93.19 |
| Rest of Louisiana | $664.81 | $88.10 |
| Rest of Maine | $686.32 | $86.80 |
| Rest of Maryland | $751.66 | $92.19 |
| Rest of Massachusetts | $779.09 | $92.90 |
| Rest of Michigan | $685.10 | $90.14 |
| Rest of Missouri | $649.25 | $87.52 |
| Rest of New Jersey | $809.09 | $97.49 |
| Rest of New York | $707.34 | $88.27 |
| Rest of Oregon | $738.69 | $89.65 |
| Rest of Pennsylvania | $687.22 | $89.00 |
| Rest of Texas | $708.06 | $89.64 |
| Rest of Washington | $778.67 | $92.48 |
| Rhode Island | $766.28 | $93.13 |
| Riverside, CA | $808.90 | $94.69 |
| Sacramento, CA | $853.34 | $95.47 |
| Salinas, CA | $850.34 | $95.08 |
| San Benito County, CA | $1,047.59 | $107.91 |
| San Diego, CA | $875.55 | $96.18 |
| San Francisco, CA | $1,024.18 | $105.35 |
| San Luis Obispo, CA | $835.94 | $93.71 |
| Santa Clara County, CA | $1,046.62 | $106.94 |
| Santa Cruz, CA | $887.97 | $96.21 |
| Santa Maria, CA | $854.95 | $95.12 |
| Santa Rosa, CA | $897.32 | $97.10 |
| South Carolina | $690.64 | $88.52 |
| South Dakota | $738.85 | $87.20 |
| Southern Maine, ME | $734.78 | $88.99 |
| Stockton, CA | $806.63 | $92.41 |
| Suburban Chicago, IL | $767.71 | $98.46 |
| Tennessee | $678.22 | $85.87 |
| Utah | $701.89 | $89.33 |
| Vallejo, CA | $959.94 | $101.07 |
| Vermont | $733.22 | $88.09 |
| Virgin Islands, VI | $750.90 | $92.08 |
| Virginia | $729.85 | $89.28 |
| Visalia, CA | $806.63 | $92.41 |
| Washington, DC area | $868.60 | $100.95 |
| West Virginia | $657.22 | $90.94 |
| Wisconsin | $710.02 | $85.74 |
| Wyoming | $741.68 | $90.03 |
| Yuba City, CA | $806.63 | $92.41 |
45350 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.
$643.98
$927.11
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 | $812.05 | 1 |
| AL | $655.25 | 1 |
| AR | $643.98 | 1 |
| AZ | $721.36 | 1 |
| CA | $806.63–$1,047.59 | 29 |
| CO | $786.25 | 1 |
| CT | $798.56 | 1 |
| DC | $868.60 | 1 |
| DE | $734.89 | 1 |
| FL | $717.04–$782.18 | 3 |
| GA | $671.23–$755.99 | 2 |
| GU | $833.95 | 1 |
| HI | $833.95 | 1 |
| IA | $681.33 | 1 |
| ID | $685.27 | 1 |
| IL | $688.14–$767.71 | 4 |
| IN | $690.13 | 1 |
| KS | $674.58 | 1 |
| KY | $667.24 | 1 |
| LA | $664.81–$704.24 | 2 |
| MA | $779.09–$877.23 | 2 |
| MD | $751.66–$868.60 | 3 |
| ME | $686.32–$734.78 | 2 |
| MI | $685.10–$724.46 | 2 |
| MN | $758.34 | 1 |
| MO | $649.25–$710.80 | 3 |
| MS | $646.92 | 1 |
| MT | $743.49 | 1 |
| NC | $695.30 | 1 |
| ND | $739.34 | 1 |
| NE | $686.65 | 1 |
| NH | $770.58 | 1 |
| NJ | $809.09–$856.51 | 2 |
| NM | $688.33 | 1 |
| NV | $743.01 | 1 |
| NY | $707.34–$881.86 | 5 |
| OH | $684.25 | 1 |
| OK | $669.00 | 1 |
| OR | $738.69–$818.25 | 2 |
| PA | $687.22–$773.79 | 2 |
| PR | $750.90 | 1 |
| RI | $766.28 | 1 |
| SC | $690.64 | 1 |
| SD | $738.85 | 1 |
| TN | $678.22 | 1 |
| TX | $681.65–$782.35 | 8 |
| UT | $701.89 | 1 |
| VA | $729.85–$868.60 | 2 |
| VI | $750.90 | 1 |
| VT | $733.22 | 1 |
| WA | $778.67–$899.71 | 2 |
| WI | $710.02 | 1 |
| WV | $657.22 | 1 |
| WY | $741.68 | 1 |
How the 45350 rate is calculated
Each of 45350’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 · 45350
RVUs × geographic indexes × conversion factor
Work1.64
1.64 RVUs× 1.000 GPCI
Practice expense20.41
20.41 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
22.2600
Conversion factor
$33.4009
Medicare rate
$743.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45350
The CMS indicators that decide how 45350 is paid alongside other services.
CMS payment indicators · 45350
Sigmoidoscopy, endoscopic band ligation
| 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
45350 without 51 · national office
$743.50
Sigmoidoscopy, endoscopic band ligation
45350-51 · Second procedure: 50%
$371.75
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%).
45350 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45330Flexible sigmoidoscopyDiagnostic
- Choose 45330 for diagnostic flexible sigmoidoscopy without band placement. Report 45350 when the scope session includes band ligation.
- 45334Flexible sigmoidoscopyEndoscopic bleeding control
- 45334 represents endoscopic control of bleeding during sigmoidoscopy; 45350 represents treatment by band ligation.
- 46221Hemorrhoid ligationRubber-band technique
- Both can describe internal hemorrhoid banding, but 45350 includes flexible sigmoidoscopy and endoscopic band placement; 46221 is the non-endoscopic approach.
45350 billing questions
When should I choose this over diagnostic sigmoidoscopy?
Use this code when the sigmoidoscopy includes band ligation. Diagnostic sigmoidoscopy describes examination without that therapeutic treatment.
Can diagnostic sigmoidoscopy be reported separately for the same session?
The examination needed to perform the band ligation is part of the therapeutic service. When related endoscopies are performed together, CMS endoscopy family pricing applies.
Is the code reported once for each band?
The code describes the band-ligation procedure, including placement of one or more bands. Document the treatment performed and target tissue.
Should modifier 50 be appended for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be billed?
CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing 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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