$238.94
Use 45330 for diagnostic flexible sigmoidoscopy without a separately described therapeutic intervention. Use 45335 when submucosal injection is performed.
On this page
CMS RVU26D · Effective 2026-10-01
45335 Flexible sigmoidoscopy Medicare reimbursement rates in Alaska
Reports flexible sigmoidoscopy when the endoscopist injects a substance into the bowel-wall submucosa, such as to mark or lift a target. Compare 45335 office and facility rates across CMS payment localities in Alaska.
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.
What does Medicare pay for 45335 in Alaska?
Alaska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$361.59
1 of 1 localities have a supported rate.
Payment area: Alaska*
One mapped payment locality.
Facility setting
$78.79
1 of 1 localities have a supported rate.
Payment area: Alaska*
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal endoscopy
About 45335: Flexible sigmoidoscopy with submucosal injection
Reports flexible sigmoidoscopy when the endoscopist injects a substance into the bowel-wall submucosa, such as to mark or lift a target.
During flexible sigmoidoscopy, the endoscopist advances a flexible instrument through the rectum into the sigmoid colon and injects a substance beneath the mucosal lining under direct visualization. Injections may mark a site for later identification or raise a lesion for endoscopic treatment. Gastroenterologists and colorectal surgeons commonly perform the service in an endoscopy unit, ambulatory surgery center, or hospital outpatient department.
Report this code when the documented sigmoidoscopy includes submucosal injection; a diagnostic examination alone, biopsy, or removal is a different service. The procedure note should identify the injection site, substance or purpose when known, and the endoscopic 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. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 45335
- 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 RVU1.01 · 10%
- Practice expense (office) RVU8.67 · 88%
- Malpractice RVU0.14 · 1%
3.1K
Medicare services in 2024 · #2154 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.
45335 compared with similar codes
Office rates for Alaska, from the same CMS release.
$357.70
45331 represents sigmoidoscopy with biopsy. Choose 45335 for submucosal injection, not tissue sampling.
$410.17
45333 is for sigmoidoscopy with polyp removal. An injection to mark or lift a target, without removal, is the distinguishing service for 45335.
Compare 45335 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alaska* →
Office / nonfacility
$361.59
Facility
$78.79
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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 45335 in Alaska*.
PPRRVU2026_Oct_nonQPP.csv
5,503
- Code
- 45335
- Physician work
- 1.01
- Practice expense
- 8.67
- Malpractice
- 0.14
GPCI2026.csv
5
- Locality
- Alaska*
- Physician work
- 1.500
- Practice expense
- 1.065
- Malpractice
- 0.551
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.01 | × 1.500 | 1.5150 |
| Practice expense | 8.67 | × 1.065 | 9.2335 |
| Malpractice | 0.14 | × 0.551 | 0.0771 |
| Total RVUs | 10.8257 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alaska*$361.59
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.01 | 1.5 |
| Practice expense | 8.67 | 1.065 |
| Malpractice | 0.14 | 0.551 |
(1.01 × 1.5 + 8.67 × 1.065 + 0.14 × 0.551) × $33.4009 = $361.59
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.01 | 1.5 |
| Practice expense | 0.72 | 1.065 |
| Malpractice | 0.14 | 0.551 |
(1.01 × 1.5 + 0.72 × 1.065 + 0.14 × 0.551) × $33.4009 = $78.79
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.
45335 billing questions
When is this code appropriate instead of a diagnostic sigmoidoscopy?
Use it when the endoscopist performs a submucosal injection during the examination. A diagnostic examination without injection is reported with the diagnostic sigmoidoscopy code.
Can the diagnostic examination be billed separately?
The sigmoidoscopy is part of the service represented by this code; do not separately report a diagnostic examination for the same scope session.
What documentation supports the injection service?
Document the injection site and the substance or clinical purpose when known, along with the endoscopic findings and work performed.
Should modifier 50 be used for injections on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
How does CMS price this with another endoscopy on the same date?
When related endoscopies are performed together, CMS endoscopy family pricing applies. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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.
5,50045332,,Sigmoidoscopy w/fb removal,A,,1.72,7.43,,0.93,,0.22,9.37,2.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50145333,,Sigmoidoscopy & polypectomy,A,,1.51,9.29,,0.86,,0.22,11.02,2.59,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50245334,,Sigmoidoscopy for bleeding,A,,1.95,14.12,,1.00,,0.22,16.29,3.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50345335,,Sigmoidoscopy w/submuc inj,A,,1.01,8.67,,0.72,,0.14,9.82,1.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50445337,,Sigmoidoscopy & decompress,A,,2.05,0.70,NA,0.70,,0.24,2.99,2.99,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50545338,,Sigmoidoscopy w/tumr remove,A,,2.00,7.78,,1.01,,0.25,10.03,3.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50645340,,Sig w/tndsc balloon dilation,A,,1.22,13.80,,0.78,,0.17,15.19,2.17,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609