Billing code 45335: Flexible sigmoidoscopyMedicare rate & RVUs in Nebraska
Reports flexible sigmoidoscopy when the endoscopist injects a substance into the bowel-wall submucosa, such as to mark or lift a target.
Medicare pays $302.79 for 45335 in the office in Nebraska (Nebraska). 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 45335 covers
During flexible sigmoidoscopy, the endoscopist advances a flexible instrument through the rectum into the sigmoid colon and injects a substance beneath the mucosal lining under direct visualization. Injections may mark a site for later identification or raise a lesion for endoscopic treatment. Gastroenterologists and colorectal surgeons commonly perform the service in an endoscopy unit, ambulatory surgery center, or hospital outpatient department.
Report this code when the documented sigmoidoscopy includes submucosal injection; a diagnostic examination alone, biopsy, or removal is a different service. The procedure note should identify the injection site, substance or purpose when known, and the endoscopic work performed. 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. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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.
45335 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $302.79 | $57.70 |
How the 45335 rate is calculated
Each of 45335’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 · 45335
RVUs × geographic indexes × conversion factor
Work1.01
1.01 RVUs× 1.000 GPCI
Practice expense8.67
8.67 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
9.8200
Conversion factor
$33.4009
Medicare rate
$328.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45335
The CMS indicators that decide how 45335 is paid alongside other services.
CMS payment indicators · 45335
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
45335 without 51 · national office
$328.00
Flexible sigmoidoscopy
45335-51 · Second procedure: 50%
$164.00
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%).
45335 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45330Flexible sigmoidoscopy
- Use 45330 for diagnostic flexible sigmoidoscopy without a separately described therapeutic intervention. Use 45335 when submucosal injection is performed.
- 45331Sigmoidoscopy
- 45331 represents sigmoidoscopy with biopsy. Choose 45335 for submucosal injection, not tissue sampling.
- 45333Flexible sigmoidoscopy
- 45333 is for sigmoidoscopy with polyp removal. An injection to mark or lift a target, without removal, is the distinguishing service for 45335.
45335 billing questions
When is this code appropriate instead of a diagnostic sigmoidoscopy?
Use it when the endoscopist performs a submucosal injection during the examination. A diagnostic examination without injection is reported with the diagnostic sigmoidoscopy code.
Can the diagnostic examination be billed separately?
The sigmoidoscopy is part of the service represented by this code; do not separately report a diagnostic examination for the same scope session.
What documentation supports the injection service?
Document the injection site and the substance or clinical purpose when known, along with the endoscopic findings and work performed.
Should modifier 50 be used for injections on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
How does CMS price this with another endoscopy on the same date?
When related endoscopies are performed together, CMS endoscopy family pricing applies. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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
Fee sheets
Put 45335 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →