Billing code 45334: Flexible sigmoidoscopyMedicare rate & RVUs in Illinois
Reports flexible endoscopic examination of the rectum and distal colon when the endoscopist actively treats a bleeding site during the procedure.
Medicare pays $507.21–$562.96 for 45334 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 45334 covers
A gastroenterologist or colorectal surgeon uses a flexible endoscope to examine the rectum and distal colon and treat a bleeding site, such as a bleeding lesion or a bleeding point seen during evaluation of hematochezia. Hemostasis may be achieved with an endoscopic technique such as injection, thermal treatment, or a clip. The code reflects treatment of bleeding, not visualization alone.
Report it when the procedure note supports endoscopic treatment intended to control bleeding, including the site and method used. A diagnostic examination performed as part of the same treatment session is not a separate service merely because the endoscopist first inspected the area. 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. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
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.
Where 45334 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$507.21 to $562.96
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $556.43 | $116.02 |
| East St. Louis | $513.82 | $110.66 |
| Rest Of Illinois | $507.21 | $107.11 |
| Suburban Chicago | $562.96 | $112.91 |
How the 45334 rate is calculated
Each of 45334’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45334
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.95Practice expense 14.12Malpractice 0.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45334
The CMS indicators that decide how 45334 is paid alongside other services.
CMS payment indicators · 45334
Flexible sigmoidoscopy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45334 without 51 · national office
$544.10
Flexible sigmoidoscopy
45334-51 · Second procedure: 50%
$272.05
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45334 compared with similar codes
Compare codes
45334 vs 45330 vs 45331 vs 45333 vs 45317: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45330Flexible sigmoidoscopy
- 45330 is for diagnostic flexible sigmoidoscopy without treatment. Use 45334 when the endoscopist treats a bleeding site during the procedure.
- 45331Sigmoidoscopy
- 45331 includes biopsy during flexible sigmoidoscopy. This code is for endoscopic treatment to control bleeding.
- 45333Flexible sigmoidoscopy
- 45333 is for snare removal of a polyp. This code is appropriate when the documented intervention is control of bleeding.
- 45317Bleeding control
- Both codes address endoscopic bleeding control, but 45317 is for rigid proctosigmoidoscopy; 45334 is for flexible sigmoidoscopy.
45334 billing questions
Can the diagnostic examination be billed separately when bleeding is treated?
The inspection that leads to treatment during the same session is part of the therapeutic service. Document the bleeding site and the treatment performed.
How does this differ from flexible sigmoidoscopy with biopsy?
Code 45331 describes a procedure that includes tissue sampling. This code describes endoscopic treatment directed at controlling bleeding.
How does this differ from the polypectomy code?
Code 45333 is for removal of a polyp by snare technique. Choose this code when the service performed is control of bleeding, rather than polyp removal.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this procedure. CMS does not permit co-surgeons or team surgery for it.
What documentation supports reporting this service?
The report should identify the bleeding site and describe the endoscopic technique used to control it. A note documenting only examination or a finding of blood does not establish that bleeding was treated.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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