$410.17
Choose 45338 when a snare removes the lesion. Choose 45333 when removal is performed with hot biopsy forceps or bipolar cautery.
On this page
CMS RVU26D · Effective 2026-10-01
45338 Flexible sigmoidoscopy Medicare reimbursement rates in Alaska
Report this service when a clinician uses a flexible sigmoidoscope to remove a polyp or other lesion in the distal colon with a snare. Compare 45338 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 45338 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
$381.55
1 of 1 localities have a supported rate.
Payment area: Alaska*
One mapped payment locality.
Facility setting
$140.73
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.
Endoscopy
About 45338: Flexible sigmoidoscopy with snare removal
Report this service when a clinician uses a flexible sigmoidoscope to remove a polyp or other lesion in the distal colon with a snare.
A clinician advances a flexible scope through the rectum to examine the distal colon and uses a snare to remove a lesion, such as a polyp found in the sigmoid colon. Gastroenterologists and colorectal surgeons commonly perform the procedure in an endoscopy unit or hospital outpatient department. The removed tissue may be submitted for pathologic examination. This code reflects snare removal, not a procedure limited to inspecting the bowel or sampling tissue with biopsy forceps.
Report the service when the procedure record supports flexible sigmoidoscopy and snare removal; document the lesion site and removal technique. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 45338
- 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 RVU2.00 · 20%
- Practice expense (office) RVU7.78 · 78%
- Malpractice RVU0.25 · 2%
6.6K
Medicare services in 2024 · #1692 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.
45338 compared with similar codes
Office rates for Alaska, from the same CMS release.
$357.70
45331 represents biopsy during flexible sigmoidoscopy; 45338 represents removal with a snare.
$238.94
45330 is diagnostic flexible sigmoidoscopy without lesion removal. Use 45338 when the examination includes snare removal.
$254.33
Both involve snare removal, but 45308 is for proctosigmoidoscopy; 45338 is for flexible sigmoidoscopy.
Compare 45338 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
$381.55
Facility
$140.73
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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 45338 in Alaska*.
PPRRVU2026_Oct_nonQPP.csv
5,505
- Code
- 45338
- Physician work
- 2.00
- Practice expense
- 7.78
- Malpractice
- 0.25
GPCI2026.csv
5
- Locality
- Alaska*
- Physician work
- 1.500
- Practice expense
- 1.065
- Malpractice
- 0.551
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.00 | × 1.500 | 3.0000 |
| Practice expense | 7.78 | × 1.065 | 8.2857 |
| Malpractice | 0.25 | × 0.551 | 0.1378 |
| Total RVUs | 11.4235 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alaska*$381.55
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2 | 1.5 |
| Practice expense | 7.78 | 1.065 |
| Malpractice | 0.25 | 0.551 |
(2 × 1.5 + 7.78 × 1.065 + 0.25 × 0.551) × $33.4009 = $381.55
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2 | 1.5 |
| Practice expense | 1.01 | 1.065 |
| Malpractice | 0.25 | 0.551 |
(2 × 1.5 + 1.01 × 1.065 + 0.25 × 0.551) × $33.4009 = $140.73
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.
45338 billing questions
How is this different from 45333?
Use 45338 for snare removal. Code 45333 describes removal using hot biopsy forceps or bipolar cautery.
Can this be reported for a biopsy alone?
No. A biopsy without snare removal is represented by the biopsy service, such as 45331.
Should the code be billed once for each polyp?
The service is the snare-removal procedure, not a per-polyp unit. Document the lesions treated and the technique used.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together; payment is not treated as unrelated procedures.
Is modifier 50 appropriate, or can an assistant be paid?
Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this code.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure's 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.
5,50245334,,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
5,50745341,,Sigmoidoscopy w/ultrasound,A,,2.07,1.04,NA,1.04,,0.23,3.34,3.34,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50845342,,Sigmoidoscopy w/us guide bx,A,,2.91,1.27,NA,1.27,,0.36,4.54,4.54,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
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