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Billing code 45342: SigmoidoscopyMedicare rate & RVUs

Reports flexible sigmoidoscopy with endoscopic ultrasound-guided needle sampling of a distal intestinal lesion or nearby target for tissue diagnosis.

CMS RVU26DEffective Oct 1, 2026109 payment localities402 Medicare services in 2024

Medicare pays $151.64 for 45342 nationally in a facility.

Medicare rate · 45342

Sigmoidoscopy

Swap in your local Medicare rate.

Work RVUs
2.91
Total RVUs
4.54
Global days
000

National rate · 2026

$151.64

Facility setting, before claim adjustments.

See every locality for 45342 → · 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 45342 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 45342 covers

This procedure combines flexible examination of the rectum and sigmoid colon with endoscopic ultrasound imaging and needle aspiration or biopsy of a target. Gastroenterologists commonly use it to sample a subepithelial rectal or sigmoid lesion, or a nearby structure, when routine mucosal forceps biopsy may not reach the target. It is typically performed in an endoscopy suite, hospital outpatient department, or ambulatory surgery center.

Report 45342 when the endoscopic ultrasound is used to guide needle tissue sampling; documentation should identify the target and show that ultrasound guidance and sampling were performed. A standard mucosal biopsy without ultrasound-guided needle sampling is a different service. 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 45342 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

45342 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$141.12
Alaska*Unavailable$197.60
ArizonaUnavailable$148.59
ArkansasUnavailable$139.83
AtlantaUnavailable$155.03
AustinUnavailable$152.92
BakersfieldUnavailable$152.86
Baltimore/Surr. CntysUnavailable$159.14
BeaumontUnavailable$146.97
BrazoriaUnavailable$149.39

45342 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
45342 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 45342 rate is calculated

Each of 45342’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 · 45342

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.91Practice expense 1.27Malpractice 0.36

4.5400 adjusted RVUs×$33.4009 conversion factor=$151.64

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

Payment rules and modifiers for 45342

The CMS indicators that decide how 45342 is paid alongside other services.

CMS payment indicators · 45342

Sigmoidoscopy

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

45342 without 51 · national facility

$151.64

Sigmoidoscopy

45342-51 · Second procedure: 50%

$75.82

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

45342 compared with similar codes

Compare codes

45342 vs 45341 vs 45331 vs 45392: national Medicare rates

Swap in your local Medicare rate.

  • 45342
    Sigmoidoscopy · 2.91 wRVU
    —
  • 45341
    Sigmoidoscopy ultrasound · 2.07 wRVU
    —
  • 45331
    Sigmoidoscopy · 1.11 wRVU
    $322.99
  • 45392
    Colonoscopy with EUS · 5.36 wRVU
    —

How to choose

45341Sigmoidoscopy ultrasound
Choose 45342 when endoscopic ultrasound guides needle aspiration or biopsy. Choose 45341 for ultrasound examination without guided needle sampling.
45331Sigmoidoscopy
45331 is for sigmoidoscopy with routine mucosal biopsy. 45342 involves ultrasound-guided needle sampling of a target.
45392Colonoscopy with EUS
45392 describes ultrasound-guided sampling performed during colonoscopy; 45342 is the sigmoidoscopy approach.

Codes related to 45342

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

Codes related to 45342
CodeHow it relatesNational office range
Same family
45341Sigmoidoscopy ultrasoundFlexible sigmoidoscopy with ultrasound examination but without ultrasound-guided needle sampling.No office rate
Used instead
45331SigmoidoscopyFlexible sigmoidoscopy with mucosal biopsy when ultrasound-guided needle sampling is not performed.$281.06–$449.20
45392Colonoscopy with EUSColonoscopy approach for endoscopic ultrasound-guided sampling when the examination extends beyond sigmoidoscopy.No office rate
43242EUS-guided biopsyUpper gastrointestinal endoscopic ultrasound-guided sampling for a target reached through the upper GI tract.No office rate

45342 billing questions

How does 45342 differ from 45341?

45342 includes endoscopic ultrasound-guided needle aspiration or biopsy. Use 45341 when ultrasound examination is performed without guided needle sampling.

Can a routine mucosal biopsy support 45342?

No. 45342 describes ultrasound-guided needle sampling; a routine forceps biopsy of the mucosal lining is a different service.

Should the diagnostic sigmoidoscopy be billed separately?

The code includes the sigmoidoscopic examination needed to perform the ultrasound-guided sampling. Do not separately report a diagnostic examination for that same service.

What documentation supports reporting 45342?

Document the lesion or target, the endoscopic ultrasound findings, and the needle aspiration or biopsy performed under ultrasound guidance.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 45342.

What happens when related endoscopies are performed together?

CMS endoscopy family pricing applies when related endoscopies are performed together. The service has a 0-day global period, so same-day preoperative and postoperative care is included.

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 45342PPRRVU2026_Oct_nonQPP.csv, line 5,508 (RVU26D)

Open CMS sourceHow we calculate rates

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