$247.21–$310.99
Use 45332 when the removal is performed with a flexible sigmoidoscope; 45307 describes rigid proctosigmoidoscopy with foreign-body removal.
On this page
CMS RVU26D · Effective 2026-10-01
45332 Flexible sigmoidoscopy Medicare reimbursement rates in California
Flexible sigmoidoscopy with endoscopic extraction of a foreign object from the rectum or sigmoid colon, reported when removal is performed during the examination. Compare 45332 office and facility rates across CMS payment localities in California.
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 45332 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$334.36–$425.57
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $91.21 per service.
Facility setting
$96.41–$112.50
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $16.09 per service.
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.
Where 45332 pays more and less in California
29 payment localities
$334.36 to $425.57
Gastrointestinal endoscopy
About 45332: Flexible sigmoidoscopy with foreign body removal
Flexible sigmoidoscopy with endoscopic extraction of a foreign object from the rectum or sigmoid colon, reported when removal is performed during the examination.
An endoscopist passes a flexible instrument through the anus to inspect the rectum and sigmoid colon and uses an endoscopic device to retrieve a foreign object encountered there. Gastroenterologists and colorectal surgeons commonly perform the procedure in an endoscopy unit or hospital outpatient setting; urgent removal may occur in a facility when an object is retained or causing symptoms. The report should identify the object and its location, document the scope extent and retrieval method, and describe the outcome or why removal could not be completed.
Report this service for endoscopic foreign-body extraction, not for inspection alone, biopsy, or polyp removal. Documentation should distinguish extraction from treatment of a lesion and identify any other endoscopic service performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare does not pay an assistant-at-surgery claim for this service under statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 45332
- 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 RVU1.72 · 18%
- Practice expense (office) RVU7.43 · 79%
- Malpractice RVU0.22 · 2%
331
Medicare services in 2024 · #3917 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.
45332 compared with similar codes
Office rates for California, from the same CMS release.
$231.34–$297.45
45330 is for diagnostic flexible sigmoidoscopy without a therapeutic removal. Use 45332 when the endoscopic service includes foreign-body extraction.
$348.45–$449.20
45331 describes flexible sigmoidoscopy with biopsy. It is not the code for retrieving a foreign object.
$395.31–$507.37
45333 describes flexible sigmoidoscopy with polyp removal. Use 45332 for foreign-body extraction rather than removal of a polyp.
Compare 45332 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $335.01 | Facility $97.06 |
| Chico | Office $334.36 | Facility $96.41 |
| El Centro | Office $334.39 | Facility $96.45 |
| Fresno | Office $334.36 | Facility $96.41 |
| Hanford-Corcoran | Office $334.36 | Facility $96.41 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $358.27 | Facility $101.43 |
| Madera | Office $334.36 | Facility $96.41 |
| Merced | Office $334.36 | Facility $96.41 |
| Modesto | Office $334.36 | Facility $96.41 |
| Napa | Office $391.89 | Facility $105.74 |
| Oxnard-Thousand Oaks-Ventura | Office $356.97 | Facility $100.35 |
| Redding | Office $334.36 | Facility $96.41 |
| Rest Of California | Office $334.36 | Facility $96.41 |
| Riverside-San Bernardino-Ontario | Office $336.74 | Facility $98.80 |
| Sacramento-Roseville-Folsom | Office $352.08 | Facility $99.58 |
| Salinas | Office $350.80 | Facility $99.17 |
| San Diego-Chula Vista-Carlsbad | Office $359.97 | Facility $100.31 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $416.20 | Facility $110.08 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $415.95 | Facility $109.83 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $425.57 | Facility $112.50 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $424.55 | Facility $111.48 |
| San Luis Obispo-Paso Robles | Office $345.03 | Facility $97.75 |
| Santa Cruz-Watsonville | Office $364.12 | Facility $100.34 |
| Santa Maria-Santa Barbara | Office $352.36 | Facility $99.22 |
| Santa Rosa-Petaluma | Office $367.86 | Facility $101.26 |
| Stockton | Office $334.36 | Facility $96.41 |
| Vallejo | Office $391.53 | Facility $105.38 |
| Visalia | Office $334.36 | Facility $96.41 |
| Yuba City | Office $334.36 | Facility $96.41 |
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45332 billing questions
How does this differ from rigid proctosigmoidoscopy with foreign-body removal?
This code describes removal using a flexible sigmoidoscope. The rigid proctosigmoidoscopy code is the alternative when the documented procedure uses a rigid instrument.
Can diagnostic inspection be reported separately?
The inspection is part of the therapeutic endoscopic service when it accompanies foreign-body removal. Use a diagnostic-only code when no removal or other therapeutic service is performed.
Can a biopsy or polypectomy be reported instead?
No. Biopsy and polyp removal are distinct services with their own flexible sigmoidoscopy codes; select the code that matches the work documented.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this descriptor and anatomy.
How does Medicare price related endoscopies performed at the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
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.
5,49745327,,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
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