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Billing code 45321: Volvulus decompressionMedicare rate & RVUs

Reports rigid proctosigmoidoscopy used to decompress a volvulus, typically during urgent treatment of sigmoid twisting and obstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities20 Medicare services in 2024

Medicare pays $98.20 for 45321 nationally in a facility.

Medicare rate · 45321

Volvulus decompression

Swap in your local Medicare rate.

Work RVUs
1.61
Total RVUs
2.94
Global days
000

National rate · 2026

$98.20

Facility setting, before claim adjustments.

See every locality for 45321 → · 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
  1. Medicare rate
  2. What 45321 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 45321 covers

A clinician advances a rigid proctosigmoidoscope through the anus to reach the rectum and distal sigmoid, then relieves the distention caused by a volvulus. The service is generally performed by a gastroenterologist or colorectal surgeon in a hospital or other acute-care setting when endoscopic decompression is indicated. The code describes therapeutic decompression, not inspection alone; a flexible sigmoidoscope used for the same purpose belongs to a different code.

Select this code when the operative report supports use of a rigid scope and documents treatment of the volvulus by decompression. Record the indication, scope approach, and therapeutic work 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 for this service. Medicare does not pay an assistant at surgery, 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 45321 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

45321 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$88.21
Alaska*Unavailable$120.59
ArizonaUnavailable$95.20
ArkansasUnavailable$86.99
AtlantaUnavailable$101.73
AustinUnavailable$98.41
BakersfieldUnavailable$96.49
Baltimore/Surr. CntysUnavailable$104.66
BeaumontUnavailable$94.47
BrazoriaUnavailable$95.20

45321 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
45321 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 45321 rate is calculated

Each of 45321’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 · 45321

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.61Practice expense 0.90Malpractice 0.43

2.9400 adjusted RVUs×$33.4009 conversion factor=$98.20

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 45321

The CMS indicators that decide how 45321 is paid alongside other services.

CMS payment indicators · 45321

Volvulus decompression

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

45321 without 51 · national facility

$98.20

Volvulus decompression

45321-51 · Second procedure: 50%

$49.10

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

45321 compared with similar codes

Compare codes

45321 vs 45337 vs 45300 vs 45330: national Medicare rates

Swap in your local Medicare rate.

  • 45321
    Volvulus decompression · 1.61 wRVU
    —
  • 45337
    Sigmoidoscopy · 2.05 wRVU
    —
  • 45300
    Proctosigmoidoscopy · 0.78 wRVU
    $148.63
  • 45330
    Flexible sigmoidoscopy · 0.82 wRVU
    $215.10

How to choose

45337Sigmoidoscopy
Both codes describe endoscopic decompression of volvulus. Choose based on the documented scope: rigid proctosigmoidoscope for 45321, flexible sigmoidoscope for 45337.
45300Proctosigmoidoscopy
45300 is diagnostic rigid proctosigmoidoscopy. Use 45321 when the rigid examination includes therapeutic decompression of a volvulus.
45330Flexible sigmoidoscopy
45330 describes diagnostic flexible sigmoidoscopy. It does not represent therapeutic decompression of volvulus with a rigid scope.

Codes related to 45321

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

Codes related to 45321
CodeHow it relatesNational office range
Used instead
45337SigmoidoscopyFlexible sigmoidoscopic decompression is the alternative when a flexible scope is used.No office rate
Same family
45300ProctosigmoidoscopyRigid proctosigmoidoscopy for diagnostic examination without the decompression service.$129.86–$201.75
45303ProctosigmoidoscopyRigid proctosigmoidoscopy with dilation, a different therapeutic service.$884.63–$1,456.49
45317Bleeding controlRigid proctosigmoidoscopy for treatment of bleeding rather than volvulus decompression.$211.56–$316.71
45320ProctosigmoidoscopyRigid proctosigmoidoscopy with ablation, a different therapeutic service.$213.95–$323.29
45327Stent placementRigid proctosigmoidoscopy with stent placement, not volvulus decompression.No office rate

45321 billing questions

How does this differ from flexible sigmoidoscopic decompression?

This code is for decompression performed with a rigid proctosigmoidoscope. Use the flexible sigmoidoscopy code when the documented approach is flexible.

Can diagnostic proctosigmoidoscopy be reported separately?

When diagnostic inspection is part of the same endoscopic session as therapeutic decompression, apply the endoscopy family pricing rules for related procedures. The record should distinguish any separate service before considering separate reporting.

Is modifier 50 appropriate?

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

What documentation supports code selection?

Document the volvulus, the use of a rigid proctosigmoidoscope, and the decompression performed. The documented approach helps distinguish this service from flexible sigmoidoscopic decompression.

Does the code include same-day care, and can an assistant be billed?

The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service.

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 45321PPRRVU2026_Oct_nonQPP.csv, line 5,496 (RVU26D)

Open CMS sourceHow we calculate rates

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