$163.00
45300 is the diagnostic rigid examination without biopsy. Report 45305 when tissue is sampled during the rigid examination.
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CMS RVU26D · Effective 2026-10-01
45305 Proctosigmoidoscopy Medicare reimbursement rates in Guam
Reports rigid examination of the rectum and distal sigmoid with tissue sampling to evaluate abnormal mucosa, a lesion, or another finding. Compare 45305 office and facility rates across CMS payment localities in Guam.
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 45305 in Guam?
Guam 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
$216.73
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$69.76
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Gastrointestinal endoscopy
About 45305: Rigid proctosigmoidoscopy with biopsy
Reports rigid examination of the rectum and distal sigmoid with tissue sampling to evaluate abnormal mucosa, a lesion, or another finding.
The clinician advances a rigid proctosigmoidoscope to inspect the rectum and distal sigmoid and takes one or more tissue samples during the examination. Common reasons include sampling abnormal mucosa, an ulcer, or a suspicious lesion. Gastroenterologists and colorectal surgeons may perform the procedure in an office or a facility-based endoscopy setting. The biopsy is part of this service; the code covers obtaining the sample, not the laboratory examination of the tissue.
Choose this code when the documented procedure uses a rigid scope and includes biopsy. A diagnostic rigid examination without biopsy is coded differently; a flexible sigmoidoscopy with biopsy is a different service. Record the scope type, examination performed, and biopsy site or sites. 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. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 45305
- 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 RVU1.12 · 19%
- Practice expense (office) RVU4.62 · 78%
- Malpractice RVU0.20 · 3%
351
Medicare services in 2024 · #3858 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.
45305 compared with similar codes
Office rates for Guam, from the same CMS release.
$359.55
45331 describes biopsy during flexible sigmoidoscopy. Choose based on the scope used, not simply on the fact that tissue was sampled.
$245.91
45308 is for lesion removal by rigid proctosigmoidoscopy. Use 45305 when tissue is sampled rather than removed as a therapeutic lesion procedure.
Compare 45305 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
Hawaii, Guam →
Office / nonfacility
$216.73
Facility
$69.76
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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 45305 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,489
- Code
- 45305
- Physician work
- 1.12
- Practice expense
- 4.62
- Malpractice
- 0.20
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.12 | × 1.000 | 1.1200 |
| Practice expense | 4.62 | × 1.137 | 5.2529 |
| Malpractice | 0.20 | × 0.579 | 0.1158 |
| Total RVUs | 6.4887 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$216.73
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.12 | 1 |
| Practice expense | 4.62 | 1.137 |
| Malpractice | 0.2 | 0.579 |
(1.12 × 1 + 4.62 × 1.137 + 0.2 × 0.579) × $33.4009 = $216.73
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.12 | 1 |
| Practice expense | 0.75 | 1.137 |
| Malpractice | 0.2 | 0.579 |
(1.12 × 1 + 0.75 × 1.137 + 0.2 × 0.579) × $33.4009 = $69.76
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.
45305 billing questions
How does this differ from 45300?
Use 45305 when the rigid proctosigmoidoscopy includes tissue sampling. Code 45300 describes the diagnostic rigid examination without biopsy.
Can I report this for a flexible sigmoidoscopy biopsy?
No. This code is for a rigid proctosigmoidoscopy with biopsy; 45331 is the corresponding flexible sigmoidoscopy biopsy service.
Is biopsy included in the procedure?
Yes. Obtaining the biopsy specimen is included in 45305. The tissue laboratory examination is a separate service when performed and reported by the appropriate laboratory provider.
Should modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this service, so do not use modifier 50.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document each service performed and do not assume each procedure receives independent full payment.
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.
5,4864526F,,Neuropsychia interven rcvd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48745300,,Proctosigmoidoscopy dx,A,,0.78,3.54,,0.44,,0.13,4.45,1.35,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48845303,,Proctosigmoidoscopy dilate,A,,1.37,29.10,,0.80,,0.23,30.70,2.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,48945305,,Proctosigmoidoscopy w/bx,A,,1.12,4.62,,0.75,,0.20,5.94,2.07,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49045307,,Proctosigmoidoscopy fb,A,,1.56,5.10,,0.89,,0.42,7.08,2.87,0,000,0.00,0.00,0.00,3,0,0,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49145308,,Proctosigmoidoscopy removal,A,,1.27,5.18,,0.82,,0.35,6.80,2.44,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49245309,,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
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014