$363.86
45333 is for lesion removal using hot biopsy forceps or bipolar cautery. Choose 45346 when the lesion is ablated rather than removed and is not amenable to those methods.
On this page
CMS RVU26D · Effective 2026-10-01
45346 Flexible sigmoidoscopy Medicare reimbursement rates in Delaware
Reports flexible sigmoidoscopy treatment that ablates a colorectal tumor, polyp, or other lesion that is not suited to standard endoscopic removal. Compare 45346 office and facility rates across CMS payment localities in Delaware.
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 45346 in Delaware?
Delaware 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
$2463.01
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$142.12
1 of 1 localities have a supported rate.
Payment area: Delaware
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 45346: Flexible sigmoidoscopy with lesion ablation
Reports flexible sigmoidoscopy treatment that ablates a colorectal tumor, polyp, or other lesion that is not suited to standard endoscopic removal.
During flexible sigmoidoscopy, the clinician examines the rectum and sigmoid colon and destroys a tumor, polyp, or other lesion endoscopically, such as with laser or electrosurgical energy. This treatment is selected when the lesion is not amenable to removal with hot biopsy forceps, bipolar cautery, or a snare. Gastroenterologists and colorectal surgeons commonly perform it in an endoscopy unit or procedure room.
Report the service when the operative note supports ablation rather than biopsy, snare removal, or another therapeutic technique. Document the lesion treated, its location, the ablation method, and why the chosen approach was used. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Do not append modifier 50; this flexible endoscopic treatment is not a bilateral procedure. CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 45346
- 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 RVU2.74 · 4%
- Practice expense (office) RVU71.54 · 96%
- Malpractice RVU0.34 · 0%
984
Medicare services in 2024 · #2982 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.
45346 compared with similar codes
Office rates for Delaware, from the same CMS release.
$331.38
45338 reports lesion removal by snare. Choose 45346 when the treatment is ablation, not snare excision.
$212.63
45330 is diagnostic flexible sigmoidoscopy without lesion ablation. When ablation is performed, the therapeutic service distinguishes 45346.
No office rate
45349 reports endoscopic mucosal resection. It differs from 45346, which describes ablation of a lesion rather than mucosal resection.
Compare 45346 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
Delaware →
Office / nonfacility
$2463.01
Facility
$142.12
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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 45346 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,509
- Code
- 45346
- Physician work
- 2.74
- Practice expense
- 71.54
- Malpractice
- 0.34
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.74 | × 1.005 | 2.7537 |
| Practice expense | 71.54 | × 0.988 | 70.6815 |
| Malpractice | 0.34 | × 0.899 | 0.3057 |
| Total RVUs | 73.7409 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$2463.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.74 | 1.005 |
| Practice expense | 71.54 | 0.988 |
| Malpractice | 0.34 | 0.899 |
(2.74 × 1.005 + 71.54 × 0.988 + 0.34 × 0.899) × $33.4009 = $2463.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.74 | 1.005 |
| Practice expense | 1.21 | 0.988 |
| Malpractice | 0.34 | 0.899 |
(2.74 × 1.005 + 1.21 × 0.988 + 0.34 × 0.899) × $33.4009 = $142.12
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.
45346 billing questions
When should this code be chosen instead of a removal code?
Use it when the lesion is ablated rather than removed and is not amenable to hot biopsy forceps, bipolar cautery, or snare removal. The operative note should identify the technique and lesion.
How does this differ from diagnostic flexible sigmoidoscopy?
A diagnostic examination reports the inspection when no ablation is performed. When a lesion is treated by ablation during the examination, report the therapeutic service instead of treating the encounter as diagnostic only.
Can biopsy or another endoscopy be reported on the same date?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Documentation should distinguish any separately performed service; do not report a diagnostic examination merely for the inspection integral to the therapeutic procedure.
Should modifier 50 be appended?
No. This is not a bilateral procedure, so modifier 50 is inappropriate.
What global-period and surgical-assistance rules apply?
The service has a 0-day global period, with same-day preoperative and postoperative care included. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery reporting are not permitted.
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.
5,50645340,,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
5,50945346,,Sigmoidoscopy w/ablation,A,,2.74,71.54,,1.21,,0.34,74.62,4.29,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,51045347,,Sigmoidoscopy w/plcmt stent,A,,2.65,1.14,NA,1.14,,0.30,4.09,4.09,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,51145349,,Sigmoidoscopy w/resection,A,,3.43,1.43,NA,1.43,,0.39,5.25,5.25,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,51245350,,Sgmdsc w/band ligation,A,,1.64,20.41,,0.90,,0.21,22.26,2.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503