Billing code 45317: Bleeding controlMedicare rate & RVUs
Reports rigid proctosigmoidoscopy used to locate and treat active bleeding in the rectum or distal sigmoid with endoscopic hemostasis.
Medicare pays $240.15 for 45317 nationally in the office and $102.54 in a hospital or facility. Local office rates run $211.56–$316.71.
Medicare rate · 45317
Bleeding control
Swap in your local Medicare rate.
- Work RVUs
- 1.85
- Total RVUs
- 7.19
- Global days
- 000
National rate · 2026
$240.15
Office setting, before claim adjustments.
See every locality for 45317 → · 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.
On this page 10 sections
What 45317 covers
A clinician advances a rigid proctosigmoidoscope through the anus to examine the rectum and distal sigmoid and treat a bleeding site. A gastroenterologist or colorectal surgeon may perform the service in an office, outpatient endoscopy unit, or hospital setting. Hemostasis may use an endoscopic technique such as cautery, injection, or another method suited to the bleeding source.
Report this code when the rigid examination includes active treatment to control bleeding, rather than a diagnostic examination alone. The procedure note should identify the bleeding site, the intervention used, and the result. 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. Bilateral adjustment is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery 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 45317 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
$211.56 to $316.71
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $214.76 | $94.35 |
| Alaska* | $277.49 | $130.93 |
| Arizona | $233.49 | $100.15 |
| Arkansas | $211.56 | $93.35 |
| Atlanta | $245.05 | $105.23 |
| Austin | $248.90 | $103.30 |
| Bakersfield | $253.57 | $102.75 |
| Baltimore/Surr. Cntys | $255.80 | $108.15 |
| Beaumont | $224.29 | $99.06 |
| Brazoria | $236.93 | $100.55 |
| Chicago | $254.40 | $116.10 |
| Chico | $252.71 | $101.89 |
| Colorado | $249.47 | $103.05 |
| Connecticut | $256.45 | $108.25 |
| Dallas | $238.61 | $101.55 |
| Dc + Md/Va Suburbs | $274.59 | $112.48 |
| Delaware | $237.43 | $101.47 |
| Detroit | $241.13 | $108.34 |
| East St. Louis | $236.85 | $110.24 |
| El Centro | $252.76 | $101.94 |
| Fort Lauderdale | $250.44 | $111.04 |
| Fort Worth | $237.06 | $101.37 |
| Fresno | $252.71 | $101.89 |
| Galveston | $237.74 | $101.10 |
| Hanford-Corcoran | $252.71 | $101.89 |
| Hawaii, Guam | $259.00 | $102.53 |
| Houston | $243.24 | $106.59 |
| Idaho | $221.40 | $94.80 |
| Indiana | $222.71 | $95.15 |
| Iowa | $219.80 | $93.89 |
| Kansas | $219.02 | $94.62 |
| Kentucky | $220.61 | $98.28 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $270.13 | $107.33 |
| Madera | $252.71 | $101.89 |
| Manhattan | $277.25 | $117.35 |
| Merced | $252.71 | $101.89 |
| Metropolitan Boston | $274.24 | $109.93 |
| Metropolitan Kansas City | $229.65 | $100.44 |
| Metropolitan Philadelphia | $250.10 | $106.85 |
| Metropolitan St. Louis | $232.09 | $101.09 |
| Miami | $262.38 | $119.12 |
| Minnesota | $237.98 | $96.38 |
| Mississippi | $214.14 | $95.65 |
| Modesto | $252.71 | $101.89 |
| Montana** | $240.13 | $102.52 |
| Napa | $292.65 | $111.28 |
| Nebraska | $220.96 | $93.94 |
| Nevada** | $238.65 | $100.90 |
| New Hampshire | $245.80 | $102.55 |
| New Mexico | $228.19 | $102.00 |
| New Orleans | $231.58 | $102.09 |
| North Carolina | $225.26 | $96.86 |
| North Dakota** | $234.20 | $96.59 |
| Northern Nj | $271.66 | $112.03 |
| Nyc Suburbs/Long Island | $284.51 | $120.89 |
| Ohio | $225.59 | $99.95 |
| Oklahoma | $219.91 | $97.02 |
| Oxnard-Thousand Oaks-Ventura | $268.74 | $106.09 |
| Portland | $257.26 | $104.38 |
| Poughkpsie/N Nyc Suburbs | $261.03 | $110.34 |
| Puerto Rico | $241.85 | $102.73 |
| Queens | $279.17 | $116.52 |
| Redding | $252.71 | $101.89 |
| Rest Of California | $252.71 | $101.89 |
| Rest Of Florida | $237.79 | $106.23 |
| Rest Of Georgia | $223.90 | $101.15 |
| Rest Of Illinois | $231.15 | $105.51 |
| Rest Of Louisiana | $220.37 | $98.59 |
| Rest Of Maine | $222.90 | $96.29 |
| Rest Of Maryland | $241.97 | $102.71 |
| Rest Of Massachusetts | $248.03 | $103.12 |
| Rest Of Michigan | $226.80 | $101.16 |
| Rest Of Missouri | $216.66 | $98.04 |
| Rest Of New Jersey | $259.08 | $108.81 |
| Rest Of New York | $228.76 | $98.03 |
| Rest Of Oregon | $236.50 | $99.44 |
| Rest Of Pennsylvania | $225.80 | $99.47 |
| Rest Of Texas | $230.60 | $100.00 |
| Rest Of Washington | $247.48 | $102.58 |
| Rhode Island | $245.80 | $103.65 |
| Riverside-San Bernardino-Ontario | $255.95 | $105.13 |
| Sacramento-Roseville-Folsom | $265.17 | $105.12 |
| Salinas | $264.18 | $104.69 |
| San Diego-Chula Vista-Carlsbad | $270.41 | $105.83 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $309.62 | $115.59 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $309.28 | $115.25 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $316.71 | $118.27 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $315.31 | $116.88 |
| San Luis Obispo-Paso Robles | $259.95 | $103.21 |
| Santa Cruz-Watsonville | $272.99 | $105.80 |
| Santa Maria-Santa Barbara | $265.18 | $104.72 |
| Santa Rosa-Petaluma | $275.74 | $106.75 |
| Seattle (King Cnty) | $279.62 | $110.77 |
| South Carolina | $225.86 | $98.70 |
| South Dakota** | $233.50 | $95.89 |
| Southern Maine | $234.94 | $98.57 |
| Stockton | $252.71 | $101.89 |
| Suburban Chicago | $252.87 | $111.54 |
| Tennessee | $220.19 | $95.11 |
| Utah | $229.03 | $99.67 |
| Vallejo | $292.16 | $110.78 |
| Vermont | $233.52 | $97.28 |
| Virgin Islands | $241.85 | $102.73 |
| Virginia | $234.34 | $99.07 |
| Visalia | $252.71 | $101.89 |
| West Virginia | $222.42 | $102.83 |
| Wisconsin | $226.15 | $94.32 |
| Wyoming** | $237.55 | $99.94 |
| Yuba City | $252.71 | $101.89 |
45317 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.
$211.56
$284.71
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 | $277.49 | 1 |
| AL | $214.76 | 1 |
| AR | $211.56 | 1 |
| AZ | $233.49 | 1 |
| CA | $252.71–$316.71 | 29 |
| CO | $249.47 | 1 |
| CT | $256.45 | 1 |
| DC | $274.59 | 1 |
| DE | $237.43 | 1 |
| FL | $237.79–$262.38 | 3 |
| GA | $223.90–$245.05 | 2 |
| GU | $259.00 | 1 |
| HI | $259.00 | 1 |
| IA | $219.80 | 1 |
| ID | $221.40 | 1 |
| IL | $231.15–$254.40 | 4 |
| IN | $222.71 | 1 |
| KS | $219.02 | 1 |
| KY | $220.61 | 1 |
| LA | $220.37–$231.58 | 2 |
| MA | $248.03–$274.24 | 2 |
| MD | $241.97–$274.59 | 3 |
| ME | $222.90–$234.94 | 2 |
| MI | $226.80–$241.13 | 2 |
| MN | $237.98 | 1 |
| MO | $216.66–$232.09 | 3 |
| MS | $214.14 | 1 |
| MT | $240.13 | 1 |
| NC | $225.26 | 1 |
| ND | $234.20 | 1 |
| NE | $220.96 | 1 |
| NH | $245.80 | 1 |
| NJ | $259.08–$271.66 | 2 |
| NM | $228.19 | 1 |
| NV | $238.65 | 1 |
| NY | $228.76–$284.51 | 5 |
| OH | $225.59 | 1 |
| OK | $219.91 | 1 |
| OR | $236.50–$257.26 | 2 |
| PA | $225.80–$250.10 | 2 |
| PR | $241.85 | 1 |
| RI | $245.80 | 1 |
| SC | $225.86 | 1 |
| SD | $233.50 | 1 |
| TN | $220.19 | 1 |
| TX | $224.29–$248.90 | 8 |
| UT | $229.03 | 1 |
| VA | $234.34–$274.59 | 2 |
| VI | $241.85 | 1 |
| VT | $233.52 | 1 |
| WA | $247.48–$279.62 | 2 |
| WI | $226.15 | 1 |
| WV | $222.42 | 1 |
| WY | $237.55 | 1 |
How the 45317 rate is calculated
Each of 45317’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 · 45317
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.85Practice expense 5.04Malpractice 0.30
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45317
The CMS indicators that decide how 45317 is paid alongside other services.
CMS payment indicators · 45317
Bleeding control
| 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
45317 without 51 · national office
$240.15
Bleeding control
45317-51 · Second procedure: 50%
$120.08
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%).
45317 compared with similar codes
Compare codes
45317 vs 45300 vs 45334 vs 45320: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45300Proctosigmoidoscopy
- 45300 describes a rigid diagnostic examination. 45317 is appropriate when the examination includes endoscopic treatment to control bleeding.
- 45334Flexible sigmoidoscopy
- 45334 is the flexible sigmoidoscopy counterpart for bleeding control. Select the code that matches the instrument used and the examination documented.
- 45320Proctosigmoidoscopy
- 45320 identifies rigid proctosigmoidoscopy with ablation. Use 45317 when the documented service is control of bleeding rather than ablation.
45317 billing questions
How is this different from diagnostic proctosigmoidoscopy?
45317 includes endoscopic treatment to control bleeding. Use the diagnostic code when the rigid examination is performed without bleeding-control treatment.
How does this differ from 45334?
Both address endoscopic control of bleeding, but 45317 is for rigid proctosigmoidoscopy and 45334 is for flexible sigmoidoscopy. Choose according to the instrument and examination documented.
Can the diagnostic examination be billed separately?
The diagnostic examination that leads to bleeding-control treatment is part of the therapeutic endoscopy. Document the treatment performed and the bleeding site.
Should modifier 50 be appended?
No. The anatomy and service make bilateral adjustment inappropriate.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document each procedure and its distinct clinical purpose.
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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