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CMS RVU26D · Effective 2026-10-01

45331 in Manhattan

Office / nonfacility

$373.66

Base rate per service

Facility setting

$75.97

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Gastroenterology

About 45331: Flexible sigmoidoscopy with biopsy

Reports flexible sigmoidoscopy with one or more tissue biopsies when a clinician samples the rectum or distal colon for diagnosis.

A clinician advances a flexible endoscope through the anus to examine the rectum and distal colon, then collects mucosal tissue for analysis. Gastroenterologists and colorectal surgeons commonly perform this service in an endoscopy unit, hospital outpatient department, or office. Typical reasons include evaluating suspected colitis, unexplained rectal bleeding, or an abnormality seen on prior testing. The biopsy may involve one or multiple tissue samples during the same examination.

Report this code when the procedure includes tissue biopsy, rather than inspection alone; the number of samples does not determine separate units. The record should identify the sampled site and clinical reason, and support that tissue was obtained. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.

CMS billing rules for 45331

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Endoscopy family pricing applies when related endoscopies are performed together.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU1.11 · 11%
  • Practice expense (office) RVU8.42 · 87%
  • Malpractice RVU0.14 · 1%

35.9K

Medicare services in 2024 · #915 by national volume

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.

45331 compared with similar codes

Office rates for Manhattan, from the same CMS release.

45330

Flexible sigmoidoscopy

Diagnostic

$248.96

45330 describes diagnostic flexible sigmoidoscopy without biopsy. Select 45331 when tissue is sampled during the examination.

45333

Flexible sigmoidoscopy

Hot biopsy forceps removal

$425.88

45333 is for polyp removal during flexible sigmoidoscopy; 45331 is for biopsy sampling. Distinguish tissue sampling from removal of a lesion.

45305

Proctosigmoidoscopy

Rigid scope with biopsy

$229.71

45305 describes biopsy during proctosigmoidoscopy. Use 45331 for biopsy performed with flexible sigmoidoscopy.

The same code, a different location

How does Manhattan compare?

In Nyc Suburbs/Long Island, the office rate for 45331 is $382.52—$8.86 higher than the $373.66 rate in Manhattan. Both use the same code, release and participation basis.

45331 across payment areas

Same release and payment basis · bars start at $0

  1. Manhattan · This locality

    $373.66

  2. Nyc Suburbs/Long Island

    $382.52

    $8.86 higher than Manhattan

  3. Poughkpsie/N Nyc Suburbs

    $352.35

    $21.31 lower than Manhattan

  4. Queens

    $378.61

    $4.95 higher than Manhattan

  5. Rest Of New York

    $307.54

    $66.12 lower than Manhattan

  6. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $374.40

    $0.74 higher than Manhattan

  7. Dc + Md/Va Suburbs

    $375.58

    $1.92 higher than Manhattan

Other payment areas listed in New York appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 45331 ranges from $281.06 in Arkansas to $449.20 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Miami

    Florida · 45331

    Office

    $341.67

    Facility

    $74.98

    $31.99 lower than Manhattan for the office setting.

  • Chicago

    Illinois · 45331

    Office

    $330.71

    Facility

    $73.24

    $42.95 lower than Manhattan for the office setting.

  • Alaska*

    Alaska · 45331

    Office

    $357.70

    Facility

    $84.87

    $15.96 lower than Manhattan for the office setting.

  • Alabama

    Alabama · 45331

    Office

    $285.80

    Facility

    $61.64

    $87.86 lower than Manhattan for the office setting.

  • Arkansas

    Arkansas · 45331

    Office

    $281.06

    Facility

    $61.00

    $92.60 lower than Manhattan for the office setting.

  • Arizona

    Arizona · 45331

    Office

    $313.60

    Facility

    $65.35

    $60.06 lower than Manhattan for the office setting.

  • Bakersfield

    California · 45331

    Office

    $348.86

    Facility

    $68.08

    $24.80 lower than Manhattan for the office setting.

  • Chico

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • El Centro

    California · 45331

    Office

    $348.47

    Facility

    $67.69

    $25.19 lower than Manhattan for the office setting.

  • Fresno

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Hanford-Corcoran

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Madera

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Merced

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Modesto

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Napa

    California · 45331

    Office

    $412.45

    Facility

    $74.80

    $38.79 higher than Manhattan for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 45331

    Office

    $373.45

    Facility

    $70.64

    $0.21 lower than Manhattan for the office setting.

  • Redding

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Rest Of California

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 45331

    Office

    $349.97

    Facility

    $69.19

    $23.69 lower than Manhattan for the office setting.

  • Sacramento-Roseville-Folsom

    California · 45331

    Office

    $367.99

    Facility

    $70.05

    $5.67 lower than Manhattan for the office setting.

  • Salinas

    California · 45331

    Office

    $366.68

    Facility

    $69.76

    $6.98 lower than Manhattan for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 45331

    Office

    $377.08

    Facility

    $70.68

    $3.42 higher than Manhattan for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 45331

    Office

    $439.29

    Facility

    $78.06

    $65.63 higher than Manhattan for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 45331

    Office

    $439.13

    Facility

    $77.91

    $65.47 higher than Manhattan for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 45331

    Office

    $449.20

    Facility

    $79.78

    $75.54 higher than Manhattan for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 45331

    Office

    $448.55

    Facility

    $79.13

    $74.89 higher than Manhattan for the office setting.

  • San Luis Obispo-Paso Robles

    California · 45331

    Office

    $360.54

    Facility

    $68.74

    $13.12 lower than Manhattan for the office setting.

  • Santa Cruz-Watsonville

    California · 45331

    Office

    $382.06

    Facility

    $70.80

    $8.40 higher than Manhattan for the office setting.

  • Santa Maria-Santa Barbara

    California · 45331

    Office

    $368.54

    Facility

    $69.83

    $5.12 lower than Manhattan for the office setting.

  • Santa Rosa-Petaluma

    California · 45331

    Office

    $386.05

    Facility

    $71.46

    $12.39 higher than Manhattan for the office setting.

  • Stockton

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Vallejo

    California · 45331

    Office

    $412.23

    Facility

    $74.57

    $38.57 higher than Manhattan for the office setting.

  • Visalia

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Yuba City

    California · 45331

    Office

    $348.45

    Facility

    $67.67

    $25.21 lower than Manhattan for the office setting.

  • Colorado

    Colorado · 45331

    Office

    $340.41

    Facility

    $67.83

    $33.25 lower than Manhattan for the office setting.

  • Connecticut

    Connecticut · 45331

    Office

    $346.37

    Facility

    $70.45

    $27.29 lower than Manhattan for the office setting.

  • Delaware

    Delaware · 45331

    Office

    $319.32

    Facility

    $66.21

    $54.34 lower than Manhattan for the office setting.

  • Fort Lauderdale

    Florida · 45331

    Office

    $330.42

    Facility

    $70.91

    $43.24 lower than Manhattan for the office setting.

  • Rest Of Florida

    Florida · 45331

    Office

    $312.96

    Facility

    $68.05

    $60.70 lower than Manhattan for the office setting.

  • Atlanta

    Georgia · 45331

    Office

    $328.54

    Facility

    $68.25

    $45.12 lower than Manhattan for the office setting.

  • Rest Of Georgia

    Georgia · 45331

    Office

    $293.51

    Facility

    $64.99

    $80.15 lower than Manhattan for the office setting.

  • Hawaii, Guam

    Hawaii · 45331

    Office

    $359.55

    Facility

    $68.27

    $14.11 lower than Manhattan for the office setting.

  • Iowa

    Iowa · 45331

    Office

    $296.26

    Facility

    $61.85

    $77.40 lower than Manhattan for the office setting.

  • Idaho

    Idaho · 45331

    Office

    $298.02

    Facility

    $62.33

    $75.64 lower than Manhattan for the office setting.

  • East St. Louis

    Illinois · 45331

    Office

    $305.23

    Facility

    $69.54

    $68.43 lower than Manhattan for the office setting.

  • Rest Of Illinois

    Illinois · 45331

    Office

    $301.15

    Facility

    $67.26

    $72.51 lower than Manhattan for the office setting.

  • Suburban Chicago

    Illinois · 45331

    Office

    $334.45

    Facility

    $71.35

    $39.21 lower than Manhattan for the office setting.

  • Indiana

    Indiana · 45331

    Office

    $300.05

    Facility

    $62.57

    $73.61 lower than Manhattan for the office setting.

  • Kansas

    Kansas · 45331

    Office

    $293.67

    Facility

    $62.08

    $79.99 lower than Manhattan for the office setting.

  • Kentucky

    Kentucky · 45331

    Office

    $291.37

    Facility

    $63.62

    $82.29 lower than Manhattan for the office setting.

  • New Orleans

    Louisiana · 45331

    Office

    $307.03

    Facility

    $65.96

    $66.63 lower than Manhattan for the office setting.

  • Rest Of Louisiana

    Louisiana · 45331

    Office

    $290.45

    Facility

    $63.72

    $83.21 lower than Manhattan for the office setting.

  • Metropolitan Boston

    Massachusetts · 45331

    Office

    $378.55

    Facility

    $72.67

    $4.89 higher than Manhattan for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 45331

    Office

    $337.54

    Facility

    $67.77

    $36.12 lower than Manhattan for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 45331

    Office

    $345.22

    Facility

    $70.33

    $28.44 lower than Manhattan for the office setting.

  • Rest Of Maryland

    Maryland · 45331

    Office

    $326.35

    Facility

    $67.09

    $47.31 lower than Manhattan for the office setting.

  • Rest Of Maine

    Maine · 45331

    Office

    $298.72

    Facility

    $63.03

    $74.94 lower than Manhattan for the office setting.

  • Southern Maine

    Maine · 45331

    Office

    $318.73

    Facility

    $64.85

    $54.93 lower than Manhattan for the office setting.

  • Detroit

    Michigan · 45331

    Office

    $316.35

    Facility

    $69.13

    $57.31 lower than Manhattan for the office setting.

  • Rest Of Michigan

    Michigan · 45331

    Office

    $299.12

    Facility

    $65.23

    $74.54 lower than Manhattan for the office setting.

  • Minnesota

    Minnesota · 45331

    Office

    $327.85

    Facility

    $64.24

    $45.81 lower than Manhattan for the office setting.

  • Metropolitan Kansas City

    Missouri · 45331

    Office

    $305.72

    Facility

    $65.17

    $67.94 lower than Manhattan for the office setting.

  • Metropolitan St. Louis

    Missouri · 45331

    Office

    $309.50

    Facility

    $65.61

    $64.16 lower than Manhattan for the office setting.

  • Rest Of Missouri

    Missouri · 45331

    Office

    $284.05

    Facility

    $63.22

    $89.61 lower than Manhattan for the office setting.

  • Mississippi

    Mississippi · 45331

    Office

    $282.67

    Facility

    $62.10

    $90.99 lower than Manhattan for the office setting.

  • Montana**

    Montana · 45331

    Office

    $322.98

    Facility

    $66.79

    $50.68 lower than Manhattan for the office setting.

  • North Carolina

    North Carolina · 45331

    Office

    $302.46

    Facility

    $63.44

    $71.20 lower than Manhattan for the office setting.

  • North Dakota**

    North Dakota · 45331

    Office

    $320.21

    Facility

    $64.02

    $53.45 lower than Manhattan for the office setting.

  • Nebraska

    Nebraska · 45331

    Office

    $298.42

    Facility

    $61.96

    $75.24 lower than Manhattan for the office setting.

  • New Hampshire

    New Hampshire · 45331

    Office

    $333.93

    Facility

    $67.24

    $39.73 lower than Manhattan for the office setting.

  • Northern Nj

    New Jersey · 45331

    Office

    $370.64

    Facility

    $73.46

    $3.02 lower than Manhattan for the office setting.

  • Rest Of New Jersey

    New Jersey · 45331

    Office

    $350.80

    Facility

    $71.04

    $22.86 lower than Manhattan for the office setting.

  • New Mexico

    New Mexico · 45331

    Office

    $300.58

    Facility

    $65.66

    $73.08 lower than Manhattan for the office setting.

  • Nevada**

    Nevada · 45331

    Office

    $322.49

    Facility

    $66.05

    $51.17 lower than Manhattan for the office setting.

  • Ohio

    Ohio · 45331

    Office

    $298.56

    Facility

    $64.66

    $75.10 lower than Manhattan for the office setting.

  • Oklahoma

    Oklahoma · 45331

    Office

    $291.85

    Facility

    $63.08

    $81.81 lower than Manhattan for the office setting.

  • Portland

    Oregon · 45331

    Office

    $353.60

    Facility

    $68.98

    $20.06 lower than Manhattan for the office setting.

  • Rest Of Oregon

    Oregon · 45331

    Office

    $320.47

    Facility

    $65.31

    $53.19 lower than Manhattan for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 45331

    Office

    $336.09

    Facility

    $69.40

    $37.57 lower than Manhattan for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 45331

    Office

    $299.67

    Facility

    $64.49

    $73.99 lower than Manhattan for the office setting.

  • Puerto Rico

    Puerto Rico · 45331

    Office

    $326.01

    Facility

    $67.01

    $47.65 lower than Manhattan for the office setting.

  • Rhode Island

    Rhode Island · 45331

    Office

    $332.47

    Facility

    $67.83

    $41.19 lower than Manhattan for the office setting.

  • South Carolina

    South Carolina · 45331

    Office

    $300.91

    Facility

    $64.20

    $72.75 lower than Manhattan for the office setting.

  • South Dakota**

    South Dakota · 45331

    Office

    $319.88

    Facility

    $63.70

    $53.78 lower than Manhattan for the office setting.

  • Tennessee

    Tennessee · 45331

    Office

    $295.23

    Facility

    $62.36

    $78.43 lower than Manhattan for the office setting.

  • Austin

    Texas · 45331

    Office

    $338.84

    Facility

    $67.80

    $34.82 lower than Manhattan for the office setting.

  • Beaumont

    Texas · 45331

    Office

    $297.34

    Facility

    $64.22

    $76.32 lower than Manhattan for the office setting.

  • Brazoria

    Texas · 45331

    Office

    $319.72

    Facility

    $65.84

    $53.94 lower than Manhattan for the office setting.

  • Dallas

    Texas · 45331

    Office

    $321.53

    Facility

    $66.37

    $52.13 lower than Manhattan for the office setting.

  • Fort Worth

    Texas · 45331

    Office

    $318.78

    Facility

    $66.18

    $54.88 lower than Manhattan for the office setting.

  • Galveston

    Texas · 45331

    Office

    $320.51

    Facility

    $66.12

    $53.15 lower than Manhattan for the office setting.

  • Houston

    Texas · 45331

    Office

    $323.07

    Facility

    $68.68

    $50.59 lower than Manhattan for the office setting.

  • Rest Of Texas

    Texas · 45331

    Office

    $308.19

    Facility

    $65.07

    $65.47 lower than Manhattan for the office setting.

  • Utah

    Utah · 45331

    Office

    $305.64

    Facility

    $64.82

    $68.02 lower than Manhattan for the office setting.

  • Virginia

    Virginia · 45331

    Office

    $316.83

    Facility

    $65.00

    $56.83 lower than Manhattan for the office setting.

  • Virgin Islands

    United States Virgin Islands · 45331

    Office

    $326.01

    Facility

    $67.01

    $47.65 lower than Manhattan for the office setting.

  • Vermont

    Vermont · 45331

    Office

    $317.86

    Facility

    $64.24

    $55.80 lower than Manhattan for the office setting.

  • Rest Of Washington

    Washington · 45331

    Office

    $337.26

    Facility

    $67.49

    $36.40 lower than Manhattan for the office setting.

  • Seattle (King Cnty)

    Washington · 45331

    Office

    $387.83

    Facility

    $73.49

    $14.17 higher than Manhattan for the office setting.

  • Wisconsin

    Wisconsin · 45331

    Office

    $307.94

    Facility

    $62.51

    $65.72 lower than Manhattan for the office setting.

  • West Virginia

    West Virginia · 45331

    Office

    $288.16

    Facility

    $65.54

    $85.50 lower than Manhattan for the office setting.

  • Wyoming**

    Wyoming · 45331

    Office

    $321.77

    Facility

    $65.59

    $51.89 lower than Manhattan for the office setting.

See how rates vary across the country

45331 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$281.06

$398.83

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$357.701
AL$285.801
AR$281.061
AZ$313.601
CA$348.45–$449.2029
CO$340.411
CT$346.371
DC$375.581
DE$319.321
FL$312.96–$341.673
GA$293.51–$328.542
GU$359.551
HI$359.551
IA$296.261
ID$298.021
IL$301.15–$334.454
IN$300.051
KS$293.671
KY$291.371
LA$290.45–$307.032
MA$337.54–$378.552
MD$326.35–$375.583
ME$298.72–$318.732
MI$299.12–$316.352
MN$327.851
MO$284.05–$309.503
MS$282.671
MT$322.981
NC$302.461
ND$320.211
NE$298.421
NH$333.931
NJ$350.80–$370.642
NM$300.581
NV$322.491
NY$307.54–$382.525
OH$298.561
OK$291.851
OR$320.47–$353.602
PA$299.67–$336.092
PR$326.011
RI$332.471
SC$300.911
SD$319.881
TN$295.231
TX$297.34–$338.848
UT$305.641
VA$316.83–$375.582
VI$326.011
VT$317.861
WA$337.26–$387.832
WI$307.941
WV$288.161
WY$321.771

Explore 45331 on the national rate map →

Where does this rate apply?

Manhattan is a Medicare payment area. Our Census mapping connects it to 1 cities and communities in New York, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in New York →

Why are the office and facility amounts different?

For 45331 in Manhattan, the physician’s office rate is $373.66 and the facility-setting rate is $75.97: a difference of $297.69.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 45331 in Manhattan. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$411.03

$373.66 × 110% = $411.03

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45331 in Manhattan.

PPRRVU2026_Oct_nonQPP.csv

5,499

Code
45331
Physician work
1.11
Practice expense
8.42
Malpractice
0.14

GPCI2026.csv

78

Locality
Manhattan
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office / nonfacility calculation for 45331 in Manhattan
ComponentRVULocality factorAdjusted
Physician work1.11× 1.0641.1810
Practice expense8.42× 1.1629.7840
Malpractice0.14× 1.5860.2220
Total RVUs11.1871
Conversion factor× 33.4009

Office / nonfacility rate, Manhattan$373.66

Open 45331 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.111.064
Practice expense8.421.162
Malpractice0.141.586

(1.11 × 1.064 + 8.42 × 1.162 + 0.14 × 1.586) × $33.4009 = $373.66

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.111.064
Practice expense0.751.162
Malpractice0.141.586

(1.11 × 1.064 + 0.75 × 1.162 + 0.14 × 1.586) × $33.4009 = $75.97

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

45331 · Office / nonfacility

$373.66

Effective 2026-10-01

The base rate is $57.66 higher than on 2025-10-01, moving from $316.00 to $373.66 (18.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $316.00changed to$373.66

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.14 changed to 1.11
    • Practice expense RVU 7.11 changed to 8.42
    • Malpractice RVU 0.16 changed to 0.14
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $316.00

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$373.66$75.97RVU26D
2026-07-01$373.66$75.97RVU26C
2026-04-01$373.66$75.97RVU26B
2026-01-01$373.66$75.97RVU26A
2025-10-01$316.00$80.66RVU25D
2025-07-01$316.00$80.66RVU25C
2025-04-01$316.00$80.66RVU25B
2025-01-01$316.00$80.66RVU25A

45331 billing questions

How does this differ from diagnostic sigmoidoscopy?

Use 45331 when the flexible examination includes tissue sampling. Use 45330 when the examination is diagnostic without biopsy or another reportable intervention.

Can multiple biopsy samples be reported as multiple units?

No. The code covers one or multiple biopsies during the sigmoidoscopy; the number of specimens alone does not create additional units.

Can the biopsy and a polypectomy be reported together?

A biopsy that is simply part of removing the same lesion should not be represented separately as a diagnostic biopsy. Distinct sampling or treatment requires documentation of what was done and where.

Should modifier 50 be used for biopsies on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, and modifier 50 should not be used.

Is same-day care included in the payment?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 45331PPRRVU2026_Oct_nonQPP.csv, line 5,499 (RVU26D)
Geographic factors for ManhattanGPCI2026.csv, line 78 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet