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Billing code 45321: Volvulus decompressionMedicare rate & RVUs in Redding

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

CMS RVU26DEffective Oct 1, 2026One payment locality20 Medicare services in 2024

In Redding, Medicare pays $95.33 for 45321 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$95.33Hospital or facility

Check a contract rate as a % of Medicare · 45321 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 45321 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Redding
  2. What 45321 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. 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.

How Redding compares for 45321

Across 109 of 109 payment localities, the facility rate for 45321 runs from $86.95 in Nebraska to $121.39 in Miami. Redding pays $95.33. The RVUs are the same everywhere; the geographic indexes change the dollars.

45321 in Redding vs other payment areas
  1. Redding · this page$95.33
  2. Bakersfield · California$96.49+$1.16
  3. Chico · California$95.33
  4. El Centro · California$95.41+$0.08
  5. Fresno · California$95.33
  6. Hanford-Corcoran · California$95.33
  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$101.08+$5.75

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

45321 in every other Medicare payment locality
Payment localityOfficeFacility
MaderaCalifornia—$95.33
MercedCalifornia—$95.33
ModestoCalifornia—$95.33
NapaCalifornia—$104.08
Oxnard-Thousand Oaks-VenturaCalifornia—$99.76
Rest Of CaliforniaCalifornia—$95.33
Riverside-San Bernardino-OntarioCalifornia—$99.94
Sacramento-Roseville-FolsomCalifornia—$98.37

45321 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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

See 45321 in every payment locality

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.

The exact Redding inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,496

Code
45321
Physician work
1.61
Practice expense
0.90
Malpractice
0.43

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Facility calculation for 45321 in Redding
ComponentRVULocality factorAdjusted
Physician work1.61× 1.0171.6374
Practice expense0.90× 1.0960.9864
Malpractice0.43× 0.5360.2305
Total RVUs2.8542
Conversion factor× 33.4009

Facility rate, Redding$95.33

Facility: (1.61 × 1.017 + 0.9 × 1.096 + 0.43 × 0.536) × $33.4009 = $95.33

Open 45321 in the RVU calculator

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

Codes related to 45321

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

Codes related to 45321
CodeHow it relatesOffice range, Redding
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.$158.41
45303ProctosigmoidoscopyRigid proctosigmoidoscopy with dilation, a different therapeutic service.$1,115.93
45317Bleeding controlRigid proctosigmoidoscopy for treatment of bleeding rather than volvulus decompression.$252.71
45320ProctosigmoidoscopyRigid proctosigmoidoscopy with ablation, a different therapeutic service.$257.06
45327Stent placementRigid proctosigmoidoscopy with stent placement, not volvulus decompression.No office rate

How 45321 has changed in Redding

45321 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$95.33RVU26D
2026-07-01Not available in this setting$95.33RVU26C
2026-04-01Not available in this setting$95.33RVU26B
2026-01-01Not available in this setting$95.33RVU26A
2025-10-01Not available in this setting$99.38RVU25D
2025-07-01Not available in this setting$99.38RVU25C
2025-04-01Not available in this setting$99.38RVU25B
2025-01-01Not available in this setting$99.38RVU25A

Price 45321 for an earlier date of service

Where the Redding rate applies

Redding is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in California

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)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)

Open CMS sourceHow we calculate rates

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