Billing code 45338: Flexible sigmoidoscopyMedicare rate & RVUs in Nevada
Report this service when a clinician uses a flexible sigmoidoscope to remove a polyp or other lesion in the distal colon with a snare.
Medicare pays $333.88 for 45338 in the office in Nevada (Nevada**). 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 45338 covers
A clinician advances a flexible scope through the rectum to examine the distal colon and uses a snare to remove a lesion, such as a polyp found in the sigmoid colon. Gastroenterologists and colorectal surgeons commonly perform the procedure in an endoscopy unit or hospital outpatient department. The removed tissue may be submitted for pathologic examination. This code reflects snare removal, not a procedure limited to inspecting the bowel or sampling tissue with biopsy forceps.
Report the service when the procedure record supports flexible sigmoidoscopy and snare removal; document the lesion site and removal technique. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. 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.
45338 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $333.88 | $107.53 |
How the 45338 rate is calculated
Each of 45338’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 · 45338
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.00Practice expense 7.78Malpractice 0.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45338
The CMS indicators that decide how 45338 is paid alongside other services.
CMS payment indicators · 45338
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
45338 without 51 · national office
$335.01
Flexible sigmoidoscopy
45338-51 · Second procedure: 50%
$167.51
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%).
45338 compared with similar codes
Compare codes
45338 vs 45333 vs 45331 vs 45330 vs 45308: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45333Flexible sigmoidoscopy
- Choose 45338 when a snare removes the lesion. Choose 45333 when removal is performed with hot biopsy forceps or bipolar cautery.
- 45331Sigmoidoscopy
- 45331 represents biopsy during flexible sigmoidoscopy; 45338 represents removal with a snare.
- 45330Flexible sigmoidoscopy
- 45330 is diagnostic flexible sigmoidoscopy without lesion removal. Use 45338 when the examination includes snare removal.
- 45308Lesion removal
- Both involve snare removal, but 45308 is for proctosigmoidoscopy; 45338 is for flexible sigmoidoscopy.
45338 billing questions
How is this different from 45333?
Use 45338 for snare removal. Code 45333 describes removal using hot biopsy forceps or bipolar cautery.
Can this be reported for a biopsy alone?
No. A biopsy without snare removal is represented by the biopsy service, such as 45331.
Should the code be billed once for each polyp?
The service is the snare-removal procedure, not a per-polyp unit. Document the lesions treated and the technique used.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together; payment is not treated as unrelated procedures.
Is modifier 50 appropriate, or can an assistant be paid?
Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this code.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the procedure's 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
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