Billing code 45333: Flexible sigmoidoscopyMedicare rate & RVUs
Reports flexible sigmoidoscopy with removal of a colorectal lesion using hot biopsy forceps, such as treatment of a polyp found in the examined segment.
Medicare pays $368.08 for 45333 nationally in the office and $86.51 in a hospital or facility. Local office rates run $320.76–$507.37.
Medicare rate · 45333
Flexible sigmoidoscopy
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- Work RVUs
- 1.51
- Total RVUs
- 11.02
- Global days
- 000
National rate · 2026
$368.08
Office setting, before claim adjustments.
See every locality for 45333 → · 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 45333 covers
A flexible sigmoidoscope is advanced through the rectum to examine the lower colon. During the examination, the endoscopist uses hot biopsy forceps to grasp and remove a lesion, commonly a small polyp. Gastroenterologists and other physicians trained in gastrointestinal endoscopy perform this service in settings such as an endoscopy center or hospital outpatient department.
Select this code when the documented removal technique is hot biopsy forceps, rather than tissue sampling alone or removal by snare. The report should identify the examined segment, lesion, and removal method. When related endoscopies are performed in the same session, CMS applies endoscopy-family pricing rather than pricing each service independently. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is barred, 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 45333 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
$320.76 to $507.37
109 of 109 payment localities
45333 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.
$320.76
$451.34
Color shows the midpoint of each state’s locality range.
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| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $410.17 | 1 |
| AL | $326.10 | 1 |
| AR | $320.76 | 1 |
| AZ | $357.40 | 1 |
| CA | $395.31–$507.37 | 29 |
| CO | $386.93 | 1 |
| CT | $394.52 | 1 |
| DC | $426.86 | 1 |
| DE | $363.86 | 1 |
| FL | $358.12–$392.04 | 3 |
| GA | $335.98–$374.67 | 2 |
| GU | $407.49 | 1 |
| HI | $407.49 | 1 |
| IA | $337.27 | 1 |
| ID | $339.38 | 1 |
| IL | $345.22–$382.48 | 4 |
| IN | $341.65 | 1 |
| KS | $334.64 | 1 |
| KY | $333.01 | 1 |
| LA | $332.09–$350.77 | 2 |
| MA | $383.84–$429.53 | 2 |
| MD | $371.70–$426.86 | 3 |
| ME | $340.48–$362.57 | 2 |
| MI | $342.03–$362.26 | 2 |
| MN | $371.90 | 1 |
| MO | $325.07–$353.20 | 3 |
| MS | $323.03 | 1 |
| MT | $368.06 | 1 |
| NC | $344.64 | 1 |
| ND | $363.71 | 1 |
| NE | $339.61 | 1 |
| NH | $379.88 | 1 |
| NJ | $399.36–$421.40 | 2 |
| NM | $343.80 | 1 |
| NV | $367.16 | 1 |
| NY | $350.38–$436.25 | 5 |
| OH | $341.14 | 1 |
| OK | $333.24 | 1 |
| OR | $364.65–$401.45 | 2 |
| PA | $342.23–$383.13 | 2 |
| PR | $371.38 | 1 |
| RI | $378.48 | 1 |
| SC | $343.39 | 1 |
| SD | $363.20 | 1 |
| TN | $336.44 | 1 |
| TX | $339.63–$385.34 | 8 |
| UT | $348.71 | 1 |
| VA | $360.64–$426.86 | 2 |
| VI | $371.38 | 1 |
| VT | $361.34 | 1 |
| WA | $383.42–$439.69 | 2 |
| WI | $349.96 | 1 |
| WV | $330.60 | 1 |
| WY | $366.17 | 1 |
How the 45333 rate is calculated
Each of 45333’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 · 45333
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.51Practice expense 9.29Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45333
The CMS indicators that decide how 45333 is paid alongside other services.
CMS payment indicators · 45333
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
45333 without 51 · national office
$368.08
Flexible sigmoidoscopy
45333-51 · Second procedure: 50%
$184.04
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%).
45333 compared with similar codes
Compare codes
45333 vs 45338 vs 45331 vs 45330: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45338Flexible sigmoidoscopy
- Both report flexible sigmoidoscopy with lesion removal. Choose 45333 for hot biopsy forceps and 45338 when removal is performed with a snare.
- 45331Sigmoidoscopy
- 45331 is for biopsy sampling; 45333 is for removal of a lesion using hot biopsy forceps.
- 45330Flexible sigmoidoscopy
- 45330 describes a diagnostic flexible sigmoidoscopy without lesion removal. Report 45333 when the examination includes hot-forceps removal.
45333 billing questions
When is this code appropriate instead of a biopsy code?
Use it when the lesion is removed with hot biopsy forceps. A procedure limited to taking tissue for examination is represented by the biopsy service.
How does this differ from snare removal?
This code identifies removal with hot biopsy forceps. Use the snare-removal code when the endoscopist removes the lesion using a snare.
How are related endoscopies in the same session paid?
CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each as an independent endoscopy.
What documentation supports reporting this service?
Document the flexible sigmoidoscopy, the lesion and its location, and that hot biopsy forceps were used to remove it.
Can modifier 50 or an assistant-at-surgery service be reported?
Modifier 50 is inappropriate for this service. CMS also bars assistant-at-surgery payment 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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