No office rate
45341 covers the endoscopic ultrasound examination; 45342 is for ultrasound-guided fine-needle aspiration or biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
45341 Sigmoidoscopy ultrasound Medicare reimbursement rates in Guam
Reports flexible sigmoidoscopy with endoscopic ultrasound to evaluate rectal or distal colonic wall layers and nearby structures. Compare 45341 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 45341 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
No supported rate
Facility setting
$113.08
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.
Gastroenterology endoscopy
About 45341: Flexible sigmoidoscopy with endoscopic ultrasound
Reports flexible sigmoidoscopy with endoscopic ultrasound to evaluate rectal or distal colonic wall layers and nearby structures.
A flexible sigmoidoscope equipped for endoscopic ultrasound is advanced into the rectum or sigmoid colon. The ultrasound images help assess bowel-wall layers and nearby tissues, such as when evaluating a rectal lesion or local disease extent. Gastroenterologists and other physicians trained in endoscopic ultrasound typically perform the service in an outpatient endoscopy unit or hospital facility.
Report 45341 when the endoscopic ultrasound examination is performed; it does not describe ultrasound-guided needle sampling, which is represented by 45342. Document the scope extent, ultrasound findings, and clinical target. The code has 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 an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 45341
- 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 RVU2.07 · 62%
- Practice expense (office) RVU1.04 · 31%
- Malpractice RVU0.23 · 7%
1.7K
Medicare services in 2024 · #2593 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.
45341 compared with similar codes
Office rates for Guam, from the same CMS release.
$238.58
45330 is diagnostic flexible sigmoidoscopy without endoscopic ultrasound. Choose 45341 when the ultrasound examination is performed.
$359.55
45331 reports flexible sigmoidoscopy with biopsy. It does not represent an endoscopic ultrasound examination or ultrasound-guided sampling.
$407.70
45378 describes diagnostic colonoscopy, a more extensive colonic examination; it does not describe rectal or sigmoid endoscopic ultrasound.
Compare 45341 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
Unavailable
Facility
$113.08
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 45341 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,507
- Code
- 45341
- Physician work
- 2.07
- Practice expense
- 1.04
- Malpractice
- 0.23
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.07 | × 1.000 | 2.0700 |
| Practice expense | 1.04 | × 1.137 | 1.1825 |
| Malpractice | 0.23 | × 0.579 | 0.1332 |
| Total RVUs | 3.3856 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$113.08
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.07 | 1 |
| Practice expense | 1.04 | 1.137 |
| Malpractice | 0.23 | 0.579 |
(2.07 × 1 + 1.04 × 1.137 + 0.23 × 0.579) × $33.4009 = $113.08
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.
45341 billing questions
How does 45341 differ from 45342?
45341 reports the endoscopic ultrasound examination. Use 45342 when the ultrasound guides fine-needle aspiration or biopsy.
Can I also report diagnostic sigmoidoscopy for the same session?
The sigmoidoscopy is part of 45341. Do not separately report a diagnostic sigmoidoscopy code for the same examination.
What documentation supports 45341?
Document the sigmoidoscope examination, the rectal or sigmoid ultrasound target, and the relevant ultrasound findings.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inapplicable to this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure.
How are related endoscopies priced when performed together?
CMS applies endoscopy family pricing when related endoscopies are performed together.
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.
5,50445337,,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
5,50545338,,Sigmoidoscopy w/tumr remove,A,,2.00,7.78,,1.01,,0.25,10.03,3.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50645340,,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
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