No office rate
Both codes describe endoscopic decompression of volvulus. Choose based on the documented scope: rigid proctosigmoidoscope for 45321, flexible sigmoidoscope for 45337.
On this page
CMS RVU26D · Effective 2026-10-01
45321 in Wyoming**
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$94.46
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.
Gastrointestinal endoscopy
About 45321: Rigid proctosigmoidoscopic volvulus decompression
Reports rigid proctosigmoidoscopy used to decompress a volvulus, typically during urgent treatment of sigmoid twisting and obstruction.
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.
CMS billing rules for 45321
- 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 RVU1.61 · 55%
- Practice expense (office) RVU0.90 · 31%
- Malpractice RVU0.43 · 15%
20
Medicare services in 2024 · #5922 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.
45321 compared with similar codes
Office rates for Wyoming**, from the same CMS release.
$147.51
45300 is diagnostic rigid proctosigmoidoscopy. Use 45321 when the rigid examination includes therapeutic decompression of a volvulus.
$214.06
45330 describes diagnostic flexible sigmoidoscopy. It does not represent therapeutic decompression of volvulus with a rigid scope.
The same code, a different location
How does Wyoming** compare?
45321 across payment areas
Same release and payment basis · bars start at $0
Wyoming** · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Wyoming appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
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
Alabama
Alabama · 45321
Office
Unavailable
Facility
$88.21
No comparable office rate is available.
Arkansas
Arkansas · 45321
Office
Unavailable
Facility
$86.99
No comparable office rate is available.
Arizona
Arizona · 45321
Office
Unavailable
Facility
$95.20
No comparable office rate is available.
Bakersfield
California · 45321
Office
Unavailable
Facility
$96.49
No comparable office rate is available.
Chico
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
El Centro
California · 45321
Office
Unavailable
Facility
$95.41
No comparable office rate is available.
Fresno
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Hanford-Corcoran
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Madera
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Merced
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Modesto
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Napa
California · 45321
Office
Unavailable
Facility
$104.08
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 45321
Office
Unavailable
Facility
$99.76
No comparable office rate is available.
Redding
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Rest Of California
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 45321
Office
Unavailable
Facility
$99.94
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 45321
Office
Unavailable
Facility
$98.37
No comparable office rate is available.
Salinas
California · 45321
Office
Unavailable
Facility
$97.98
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 45321
Office
Unavailable
Facility
$99.13
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 45321
Office
Unavailable
Facility
$107.86
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 45321
Office
Unavailable
Facility
$107.37
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 45321
Office
Unavailable
Facility
$110.74
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 45321
Office
Unavailable
Facility
$108.74
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 45321
Office
Unavailable
Facility
$96.63
No comparable office rate is available.
Santa Cruz-Watsonville
California · 45321
Office
Unavailable
Facility
$99.13
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 45321
Office
Unavailable
Facility
$98.03
No comparable office rate is available.
Santa Rosa-Petaluma
California · 45321
Office
Unavailable
Facility
$100.00
No comparable office rate is available.
Stockton
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Vallejo
California · 45321
Office
Unavailable
Facility
$103.38
No comparable office rate is available.
Visalia
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Yuba City
California · 45321
Office
Unavailable
Facility
$95.33
No comparable office rate is available.
Colorado
Colorado · 45321
Office
Unavailable
Facility
$97.62
No comparable office rate is available.
Connecticut
Connecticut · 45321
Office
Unavailable
Facility
$104.60
No comparable office rate is available.
Delaware
Delaware · 45321
Office
Unavailable
Facility
$96.66
No comparable office rate is available.
Fort Lauderdale
Florida · 45321
Office
Unavailable
Facility
$110.19
No comparable office rate is available.
Rest Of Florida
Florida · 45321
Office
Unavailable
Facility
$104.10
No comparable office rate is available.
Atlanta
Georgia · 45321
Office
Unavailable
Facility
$101.73
No comparable office rate is available.
Rest Of Georgia
Georgia · 45321
Office
Unavailable
Facility
$97.71
No comparable office rate is available.
Hawaii, Guam
Hawaii · 45321
Office
Unavailable
Facility
$96.27
No comparable office rate is available.
Iowa
Iowa · 45321
Office
Unavailable
Facility
$86.98
No comparable office rate is available.
Idaho
Idaho · 45321
Office
Unavailable
Facility
$88.22
No comparable office rate is available.
East St. Louis
Illinois · 45321
Office
Unavailable
Facility
$110.36
No comparable office rate is available.
Rest Of Illinois
Illinois · 45321
Office
Unavailable
Facility
$103.67
No comparable office rate is available.
Suburban Chicago
Illinois · 45321
Office
Unavailable
Facility
$110.47
No comparable office rate is available.
Indiana
Indiana · 45321
Office
Unavailable
Facility
$88.62
No comparable office rate is available.
Kansas
Kansas · 45321
Office
Unavailable
Facility
$88.19
No comparable office rate is available.
Kentucky
Kentucky · 45321
Office
Unavailable
Facility
$93.64
No comparable office rate is available.
New Orleans
Louisiana · 45321
Office
Unavailable
Facility
$98.38
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 45321
Office
Unavailable
Facility
$94.14
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 45321
Office
Unavailable
Facility
$104.66
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 45321
Office
Unavailable
Facility
$97.74
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 45321
Office
Unavailable
Facility
$104.66
No comparable office rate is available.
Rest Of Maryland
Maryland · 45321
Office
Unavailable
Facility
$97.92
No comparable office rate is available.
Rest Of Maine
Maine · 45321
Office
Unavailable
Facility
$90.36
No comparable office rate is available.
Southern Maine
Maine · 45321
Office
Unavailable
Facility
$92.63
No comparable office rate is available.
Detroit
Michigan · 45321
Office
Unavailable
Facility
$107.00
No comparable office rate is available.
Rest Of Michigan
Michigan · 45321
Office
Unavailable
Facility
$97.44
No comparable office rate is available.
Minnesota
Minnesota · 45321
Office
Unavailable
Facility
$88.96
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 45321
Office
Unavailable
Facility
$96.03
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 45321
Office
Unavailable
Facility
$96.78
No comparable office rate is available.
Rest Of Missouri
Missouri · 45321
Office
Unavailable
Facility
$93.68
No comparable office rate is available.
Mississippi
Mississippi · 45321
Office
Unavailable
Facility
$90.27
No comparable office rate is available.
Montana**
Montana · 45321
Office
Unavailable
Facility
$98.17
No comparable office rate is available.
North Carolina
North Carolina · 45321
Office
Unavailable
Facility
$91.00
No comparable office rate is available.
North Dakota**
North Dakota · 45321
Office
Unavailable
Facility
$89.67
No comparable office rate is available.
Nebraska
Nebraska · 45321
Office
Unavailable
Facility
$86.95
No comparable office rate is available.
New Hampshire
New Hampshire · 45321
Office
Unavailable
Facility
$97.64
No comparable office rate is available.
Northern Nj
New Jersey · 45321
Office
Unavailable
Facility
$107.37
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 45321
Office
Unavailable
Facility
$104.51
No comparable office rate is available.
New Mexico
New Mexico · 45321
Office
Unavailable
Facility
$98.59
No comparable office rate is available.
Nevada**
Nevada · 45321
Office
Unavailable
Facility
$95.83
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 45321
Office
Unavailable
Facility
$119.63
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 45321
Office
Unavailable
Facility
$106.49
No comparable office rate is available.
Queens
New York · 45321
Office
Unavailable
Facility
$113.46
No comparable office rate is available.
Rest Of New York
New York · 45321
Office
Unavailable
Facility
$92.43
No comparable office rate is available.
Ohio
Ohio · 45321
Office
Unavailable
Facility
$95.70
No comparable office rate is available.
Oklahoma
Oklahoma · 45321
Office
Unavailable
Facility
$91.78
No comparable office rate is available.
Portland
Oregon · 45321
Office
Unavailable
Facility
$98.72
No comparable office rate is available.
Rest Of Oregon
Oregon · 45321
Office
Unavailable
Facility
$93.81
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 45321
Office
Unavailable
Facility
$103.17
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 45321
Office
Unavailable
Facility
$94.94
No comparable office rate is available.
Puerto Rico
Puerto Rico · 45321
Office
Unavailable
Facility
$98.31
No comparable office rate is available.
Rhode Island
Rhode Island · 45321
Office
Unavailable
Facility
$98.66
No comparable office rate is available.
South Carolina
South Carolina · 45321
Office
Unavailable
Facility
$93.76
No comparable office rate is available.
South Dakota**
South Dakota · 45321
Office
Unavailable
Facility
$88.66
No comparable office rate is available.
Tennessee
Tennessee · 45321
Office
Unavailable
Facility
$88.81
No comparable office rate is available.
Austin
Texas · 45321
Office
Unavailable
Facility
$98.41
No comparable office rate is available.
Beaumont
Texas · 45321
Office
Unavailable
Facility
$94.47
No comparable office rate is available.
Brazoria
Texas · 45321
Office
Unavailable
Facility
$95.20
No comparable office rate is available.
Dallas
Texas · 45321
Office
Unavailable
Facility
$96.52
No comparable office rate is available.
Fort Worth
Texas · 45321
Office
Unavailable
Facility
$96.41
No comparable office rate is available.
Galveston
Texas · 45321
Office
Unavailable
Facility
$95.95
No comparable office rate is available.
Houston
Texas · 45321
Office
Unavailable
Facility
$103.82
No comparable office rate is available.
Rest Of Texas
Texas · 45321
Office
Unavailable
Facility
$95.27
No comparable office rate is available.
Utah
Utah · 45321
Office
Unavailable
Facility
$94.93
No comparable office rate is available.
Virginia
Virginia · 45321
Office
Unavailable
Facility
$93.47
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 45321
Office
Unavailable
Facility
$98.31
No comparable office rate is available.
Vermont
Vermont · 45321
Office
Unavailable
Facility
$90.80
No comparable office rate is available.
Rest Of Washington
Washington · 45321
Office
Unavailable
Facility
$97.06
No comparable office rate is available.
Seattle (King Cnty)
Washington · 45321
Office
Unavailable
Facility
$105.08
No comparable office rate is available.
Wisconsin
Wisconsin · 45321
Office
Unavailable
Facility
$87.00
No comparable office rate is available.
West Virginia
West Virginia · 45321
Office
Unavailable
Facility
$100.45
No comparable office rate is available.
See how rates vary across the country
45321 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 45321 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$103.91
$94.46 × 110% = $103.91
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.
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 45321 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,496
- Code
- 45321
- Physician work
- 1.61
- Practice expense
- 0.90
- Malpractice
- 0.43
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.61 | × 1.000 | 1.6100 |
| Practice expense | 0.90 | × 1.000 | 0.9000 |
| Malpractice | 0.43 | × 0.740 | 0.3182 |
| Total RVUs | 2.8282 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$94.46
Open 45321 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.61 | 1 |
| Practice expense | 0.9 | 1 |
| Malpractice | 0.43 | 0.74 |
(1.61 × 1 + 0.9 × 1 + 0.43 × 0.74) × $33.4009 = $94.46
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
45321 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
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 from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $94.46 | RVU26D |
| 2026-07-01 | Not available in this setting | $94.46 | RVU26C |
| 2026-04-01 | Not available in this setting | $94.46 | RVU26B |
| 2026-01-01 | Not available in this setting | $94.46 | RVU26A |
| 2025-10-01 | Not available in this setting | $97.94 | RVU25D |
| 2025-07-01 | Not available in this setting | $97.94 | RVU25C |
| 2025-04-01 | Not available in this setting | $97.94 | RVU25B |
| 2025-01-01 | Not available in this setting | $97.94 | RVU25A |
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 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.
5,49345315,,Proctosigmoidoscopy removal,A,,1.66,5.43,,0.91,,0.43,7.52,3.00,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49445317,,Proctosigmoidoscopy bleed,A,,1.85,5.04,,0.92,,0.30,7.19,3.07,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49545320,,Proctosigmoidoscopy ablate,A,,1.64,5.29,,0.91,,0.43,7.36,2.98,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49645321,,Proctosigmoidoscopy volvul,A,,1.61,0.90,NA,0.90,,0.43,2.94,2.94,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49745327,,Proctosigmoidoscopy w/stent,A,,1.85,0.96,NA,0.96,,0.48,3.29,3.29,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49845330,,Diagnostic sigmoidoscopy,A,,0.82,5.50,,0.67,,0.12,6.44,1.61,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,49945331,,Sigmoidoscopy and biopsy,A,,1.11,8.42,,0.75,,0.14,9.67,2.00,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,