$357.22–$453.34
Both report flexible sigmoidoscopy with lesion removal. Choose 45333 for hot biopsy forceps and 45338 when removal is performed with a snare.
On this page
CMS RVU26D · Effective 2026-10-01
45333 Flexible sigmoidoscopy Medicare reimbursement rates in California
Reports flexible sigmoidoscopy with removal of a colorectal lesion using hot biopsy forceps, such as treatment of a polyp found in the examined segment. Compare 45333 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 45333 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
$395.31–$507.37
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $112.06 per service.
Facility setting
$86.71–$101.34
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $14.63 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 45333 pays more and less in California
29 payment localities
$395.31 to $507.37
Gastrointestinal endoscopy
About 45333: Flexible sigmoidoscopy with hot-forceps lesion removal
Reports flexible sigmoidoscopy with removal of a colorectal lesion using hot biopsy forceps, such as treatment of a polyp found in the examined segment.
A flexible sigmoidoscope is advanced through the rectum to examine the lower colon. During the examination, the endoscopist uses hot biopsy forceps to grasp and remove a lesion, commonly a small polyp. Gastroenterologists and other physicians trained in gastrointestinal endoscopy perform this service in settings such as an endoscopy center or hospital outpatient department.
Select this code when the documented removal technique is hot biopsy forceps, rather than tissue sampling alone or removal by snare. The report should identify the examined segment, lesion, and removal method. When related endoscopies are performed in the same session, CMS applies endoscopy-family pricing rather than pricing each service independently. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is barred, and co-surgeons and team surgery are not permitted.
CMS billing rules for 45333
- 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 RVU1.51 · 14%
- Practice expense (office) RVU9.29 · 84%
- Malpractice RVU0.22 · 2%
514
Medicare services in 2024 · #3542 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.
45333 compared with similar codes
Office rates for California, from the same CMS release.
$348.45–$449.20
45331 is for biopsy sampling; 45333 is for removal of a lesion using hot biopsy forceps.
$231.34–$297.45
45330 describes a diagnostic flexible sigmoidoscopy without lesion removal. Report 45333 when the examination includes hot-forceps removal.
Compare 45333 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 $395.95 | Facility $87.35 |
| Chico | Office $395.31 | Facility $86.71 |
| El Centro | Office $395.35 | Facility $86.75 |
| Fresno | Office $395.31 | Facility $86.71 |
| Hanford-Corcoran | Office $395.31 | Facility $86.71 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $424.46 | Facility $91.36 |
| Madera | Office $395.31 | Facility $86.71 |
| Merced | Office $395.31 | Facility $86.71 |
| Modesto | Office $395.31 | Facility $86.71 |
| Napa | Office $466.31 | Facility $95.20 |
| Oxnard-Thousand Oaks-Ventura | Office $423.19 | Facility $90.38 |
| Redding | Office $395.31 | Facility $86.71 |
| Rest Of California | Office $395.31 | Facility $86.71 |
| Riverside-San Bernardino-Ontario | Office $397.69 | Facility $89.09 |
| Sacramento-Roseville-Folsom | Office $417.06 | Facility $89.60 |
| Salinas | Office $415.57 | Facility $89.23 |
| San Diego-Chula Vista-Carlsbad | Office $427.04 | Facility $90.29 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $496.11 | Facility $99.10 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $495.86 | Facility $98.85 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $507.37 | Facility $101.34 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $506.34 | Facility $100.32 |
| San Luis Obispo-Paso Robles | Office $408.66 | Facility $87.95 |
| Santa Cruz-Watsonville | Office $432.44 | Facility $90.33 |
| Santa Maria-Santa Barbara | Office $417.59 | Facility $89.28 |
| Santa Rosa-Petaluma | Office $436.93 | Facility $91.16 |
| Stockton | Office $395.31 | Facility $86.71 |
| Vallejo | Office $465.95 | Facility $94.84 |
| Visalia | Office $395.31 | Facility $86.71 |
| Yuba City | Office $395.31 | Facility $86.71 |
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45333 billing questions
When is this code appropriate instead of a biopsy code?
Use it when the lesion is removed with hot biopsy forceps. A procedure limited to taking tissue for examination is represented by the biopsy service.
How does this differ from snare removal?
This code identifies removal with hot biopsy forceps. Use the snare-removal code when the endoscopist removes the lesion using a snare.
How are related endoscopies in the same session paid?
CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each as an independent endoscopy.
What documentation supports reporting this service?
Document the flexible sigmoidoscopy, the lesion and its location, and that hot biopsy forceps were used to remove it.
Can modifier 50 or an assistant-at-surgery service be reported?
Modifier 50 is inappropriate for this service. CMS also bars assistant-at-surgery payment and does not permit co-surgeons or team surgery.
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.
5,49845330,,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
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