Billing code 45320: ProctosigmoidoscopyMedicare rate & RVUs
Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal.
Medicare pays $245.83 for 45320 nationally in the office and $99.53 in a hospital or facility. Local office rates run $213.95–$323.29.
Medicare rate · 45320
Proctosigmoidoscopy
Swap in your local Medicare rate.
- Work RVUs
- 1.64
- Total RVUs
- 7.36
- Global days
- 000
National rate · 2026
$245.83
Office setting, before claim adjustments.
See every locality for 45320 → · 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 45320 covers
During rigid proctosigmoidoscopy, the clinician examines the rectum and distal sigmoid through a rigid scope and destroys a tumor, polyp, or other lesion that is not suitable for removal with hot biopsy forceps, bipolar cautery, or a snare. This is a therapeutic procedure rather than inspection or tissue sampling alone. Gastroenterologists and colorectal surgeons may perform it in an endoscopy unit or operating room, depending on access and the patient's needs.
Report 45320 for the ablation service when the documented lesion and treatment fit this rigid-scope procedure; use a removal code when the lesion is excised instead. The procedure note should identify the lesion, its site, and the ablative treatment. 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. Assistant-at-surgery payment is barred, and co-surgery 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 45320 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
$213.95 to $323.29
109 of 109 payment localities
45320 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.
$213.95
$290.18
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 | $278.26 | 1 |
| AL | $217.51 | 1 |
| AR | $213.95 | 1 |
| AZ | $238.29 | 1 |
| CA | $257.06–$323.29 | 29 |
| CO | $254.65 | 1 |
| CT | $263.55 | 1 |
| DC | $281.86 | 1 |
| DE | $242.53 | 1 |
| FL | $245.28–$275.04 | 3 |
| GA | $229.51–$251.71 | 2 |
| GU | $263.99 | 1 |
| HI | $263.99 | 1 |
| IA | $222.15 | 1 |
| ID | $224.13 | 1 |
| IL | $238.54–$265.70 | 4 |
| IN | $225.55 | 1 |
| KS | $221.74 | 1 |
| KY | $225.00 | 1 |
| LA | $224.91–$237.36 | 2 |
| MA | $253.16–$280.77 | 2 |
| MD | $247.32–$281.86 | 3 |
| ME | $226.27–$238.94 | 2 |
| MI | $232.31–$249.50 | 2 |
| MN | $240.84 | 1 |
| MO | $221.07–$237.38 | 3 |
| MS | $217.52 | 1 |
| MT | $245.80 | 1 |
| NC | $228.81 | 1 |
| ND | $237.30 | 1 |
| NE | $223.29 | 1 |
| NH | $251.28 | 1 |
| NJ | $265.67–$278.53 | 2 |
| NM | $234.05 | 1 |
| NV | $243.61 | 1 |
| NY | $232.73–$295.04 | 5 |
| OH | $230.57 | 1 |
| OK | $223.72 | 1 |
| OR | $240.86–$262.64 | 2 |
| PA | $230.55–$256.83 | 2 |
| PR | $247.56 | 1 |
| RI | $251.15 | 1 |
| SC | $230.25 | 1 |
| SD | $236.29 | 1 |
| TN | $223.10 | 1 |
| TX | $228.91–$254.55 | 8 |
| UT | $233.76 | 1 |
| VA | $238.60–$281.86 | 2 |
| VI | $247.56 | 1 |
| VT | $236.97 | 1 |
| WA | $252.47–$286.05 | 2 |
| WI | $228.47 | 1 |
| WV | $228.87 | 1 |
| WY | $242.10 | 1 |
How the 45320 rate is calculated
Each of 45320’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 · 45320
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.64Practice expense 5.29Malpractice 0.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45320
The CMS indicators that decide how 45320 is paid alongside other services.
CMS payment indicators · 45320
Proctosigmoidoscopy
| 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
45320 without 51 · national office
$245.83
Proctosigmoidoscopy
45320-51 · Second procedure: 50%
$122.92
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%).
45320 compared with similar codes
Compare codes
45320 vs 45308 vs 45309 vs 45346 vs 45300: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45308Lesion removal
- Use 45308 for lesion removal with hot biopsy forceps or bipolar cautery. Use 45320 when the lesion is ablated rather than removed by that method.
- 45309Proctosigmoidoscopy
- 45309 describes lesion removal by snare. 45320 describes ablation of a lesion not suitable for conventional removal.
- 45346Flexible sigmoidoscopy
- Both involve lesion ablation; 45320 uses rigid proctosigmoidoscopy, while 45346 is performed with flexible sigmoidoscopy.
- 45300Proctosigmoidoscopy
- 45300 is diagnostic rigid proctosigmoidoscopy. Choose 45320 when the service includes therapeutic lesion ablation.
45320 billing questions
How does 45320 differ from 45308 or 45309?
45320 is for ablation of a lesion not suitable for conventional removal. Codes 45308 and 45309 describe lesion removal using hot biopsy forceps or bipolar cautery, and snare technique, respectively.
How does this code differ from 45346?
Both describe lesion ablation, but 45320 is for rigid proctosigmoidoscopy. Code 45346 describes ablation during flexible sigmoidoscopy.
What should the procedure note document?
Document the lesion's location and the ablative treatment performed, including why the service was ablation rather than conventional forceps or snare removal.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are same-day care and surgical assistance paid separately?
The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay for an assistant at surgery, and does not permit co-surgeons or team surgery.
What happens when related endoscopies are performed together?
CMS applies endoscopy family pricing when related endoscopies are performed together, rather than pricing each related scope as an entirely independent procedure.
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
Fee sheets
Put 45320 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →