$220.08
Use 45308 for lesion removal with hot biopsy forceps or bipolar cautery. Use 45320 when the lesion is ablated rather than removed by that method.
On this page
CMS RVU26D · Effective 2026-10-01
45320 Proctosigmoidoscopy Medicare reimbursement rates in Arizona
Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal. Compare 45320 office and facility rates across CMS payment localities in Arizona.
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 45320 in Arizona?
Arizona 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
$238.29
1 of 1 localities have a supported rate.
Payment area: Arizona
One mapped payment locality.
Facility setting
$96.52
1 of 1 localities have a supported rate.
Payment area: Arizona
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 45320: Rigid proctosigmoidoscopy with lesion ablation
Rigid proctosigmoidoscopy with lesion ablation is reported when a rectal or distal sigmoid lesion requires destruction rather than conventional forceps or snare removal.
During rigid proctosigmoidoscopy, the clinician examines the rectum and distal sigmoid through a rigid scope and destroys a tumor, polyp, or other lesion that is not suitable for removal with hot biopsy forceps, bipolar cautery, or a snare. This is a therapeutic procedure rather than inspection or tissue sampling alone. Gastroenterologists and colorectal surgeons may perform it in an endoscopy unit or operating room, depending on access and the patient's needs.
Report 45320 for the ablation service when the documented lesion and treatment fit this rigid-scope procedure; use a removal code when the lesion is excised instead. The procedure note should identify the lesion, its site, and the ablative treatment. 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. Assistant-at-surgery payment is barred, and co-surgery and team surgery are not permitted.
CMS billing rules for 45320
- 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 RVU1.64 · 22%
- Practice expense (office) RVU5.29 · 72%
- Malpractice RVU0.43 · 6%
11
Medicare services in 2024 · #6165 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.
45320 compared with similar codes
Office rates for Arizona, from the same CMS release.
$226.90
45309 describes lesion removal by snare. 45320 describes ablation of a lesion not suitable for conventional removal.
$2,416.67
Both involve lesion ablation; 45320 uses rigid proctosigmoidoscopy, while 45346 is performed with flexible sigmoidoscopy.
$144.34
45300 is diagnostic rigid proctosigmoidoscopy. Choose 45320 when the service includes therapeutic lesion ablation.
Compare 45320 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
Arizona →
Office / nonfacility
$238.29
Facility
$96.52
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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 45320 in Arizona.
PPRRVU2026_Oct_nonQPP.csv
5,495
- Code
- 45320
- Physician work
- 1.64
- Practice expense
- 5.29
- Malpractice
- 0.43
GPCI2026.csv
6
- Locality
- Arizona
- Physician work
- 1.000
- Practice expense
- 0.969
- Malpractice
- 0.856
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.64 | × 1.000 | 1.6400 |
| Practice expense | 5.29 | × 0.969 | 5.1260 |
| Malpractice | 0.43 | × 0.856 | 0.3681 |
| Total RVUs | 7.1341 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Arizona$238.29
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 5.29 | 0.969 |
| Malpractice | 0.43 | 0.856 |
(1.64 × 1 + 5.29 × 0.969 + 0.43 × 0.856) × $33.4009 = $238.29
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 0.91 | 0.969 |
| Malpractice | 0.43 | 0.856 |
(1.64 × 1 + 0.91 × 0.969 + 0.43 × 0.856) × $33.4009 = $96.52
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.
45320 billing questions
How does 45320 differ from 45308 or 45309?
45320 is for ablation of a lesion not suitable for conventional removal. Codes 45308 and 45309 describe lesion removal using hot biopsy forceps or bipolar cautery, and snare technique, respectively.
How does this code differ from 45346?
Both describe lesion ablation, but 45320 is for rigid proctosigmoidoscopy. Code 45346 describes ablation during flexible sigmoidoscopy.
What should the procedure note document?
Document the lesion's location and the ablative treatment performed, including why the service was ablation rather than conventional forceps or snare removal.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are same-day care and surgical assistance paid separately?
The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay for an assistant at surgery, and does not permit co-surgeons or team surgery.
What happens when related endoscopies are performed together?
CMS applies endoscopy family pricing when related endoscopies are performed together, rather than pricing each related scope as an entirely independent procedure.
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.
5,49245309,,Proctosigmoidoscopy removal,A,,1.37,5.27,,0.84,,0.37,7.01,2.58,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49345315,,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
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
901112,CA,55,CHICO,1.017,1.096,0.536