$629.09
45386 describes transendoscopic balloon dilation during colonoscopy. Choose 45340 when the performed examination is flexible sigmoidoscopy.
On this page
CMS RVU26D · Effective 2026-10-01
45340 Sigmoidoscopy dilation Medicare reimbursement rates in New Mexico
Reports flexible sigmoidoscopy in which an endoscopist passes and inflates a balloon through the scope to widen a rectal or sigmoid stricture. Compare 45340 office and facility rates across CMS payment localities in New Mexico.
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 45340 in New Mexico?
New Mexico 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
$470.24
1 of 1 localities have a supported rate.
Payment area: New Mexico
One mapped payment locality.
Facility setting
$71.46
1 of 1 localities have a supported rate.
Payment area: New Mexico
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 45340: Flexible sigmoidoscopy with balloon dilation
Reports flexible sigmoidoscopy in which an endoscopist passes and inflates a balloon through the scope to widen a rectal or sigmoid stricture.
During flexible sigmoidoscopy, the endoscopist guides a dilation balloon through the scope to a narrowed area in the rectum or sigmoid colon, then inflates it under endoscopic visualization to enlarge the passage. Gastroenterologists and colorectal surgeons commonly perform this treatment for a stricture that limits passage through the distal bowel, including a narrowing at a surgical anastomosis. The procedure may take place in an endoscopy unit or hospital outpatient setting.
Report 45340 when the flexible sigmoidoscopy includes transendoscopic balloon dilation; diagnostic inspection alone is not the dilation service. The procedure note should identify the narrowed site and document balloon dilation. 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 an assistant at surgery for this code, and co-surgery and team surgery are not permitted.
CMS billing rules for 45340
- 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 RVU1.22 · 8%
- Practice expense (office) RVU13.80 · 91%
- Malpractice RVU0.17 · 1%
1K
Medicare services in 2024 · #2957 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.
45340 compared with similar codes
Office rates for New Mexico, from the same CMS release.
$946.28
45303 describes dilation with proctosigmoidoscopy. 45340 is for balloon dilation performed through a flexible sigmoidoscope.
$200.66
45330 is diagnostic flexible sigmoidoscopy; 45340 requires balloon dilation of a stricture during the examination.
Compare 45340 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
New Mexico →
Office / nonfacility
$470.24
Facility
$71.46
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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 45340 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
5,506
- Code
- 45340
- Physician work
- 1.22
- Practice expense
- 13.80
- Malpractice
- 0.17
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.22 | × 1.000 | 1.2200 |
| Practice expense | 13.80 | × 0.917 | 12.6546 |
| Malpractice | 0.17 | × 1.201 | 0.2042 |
| Total RVUs | 14.0788 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, New Mexico$470.24
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.22 | 1 |
| Practice expense | 13.8 | 0.917 |
| Malpractice | 0.17 | 1.201 |
(1.22 × 1 + 13.8 × 0.917 + 0.17 × 1.201) × $33.4009 = $470.24
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.22 | 1 |
| Practice expense | 0.78 | 0.917 |
| Malpractice | 0.17 | 1.201 |
(1.22 × 1 + 0.78 × 0.917 + 0.17 × 1.201) × $33.4009 = $71.46
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.
45340 billing questions
When should 45340 be chosen over 45330?
Use 45340 when a balloon is passed through the flexible sigmoidoscope and inflated to widen a stricture. Use 45330 for diagnostic flexible sigmoidoscopy without that therapeutic dilation.
Can the diagnostic sigmoidoscopy be reported separately?
Inspection of the bowel as part of the dilation procedure is integral to reporting 45340. Do not separately report a diagnostic examination for that same scope passage.
What documentation supports 45340?
Document the stricture's location and the transendoscopic balloon dilation performed. The record should make clear that dilation, rather than inspection alone, was carried out.
Should modifier 50 be appended for a stricture on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the sigmoidoscopy dilation without modifier 50.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 45340. Co-surgeons and team surgery are not permitted for this code.
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.
5,50345335,,Sigmoidoscopy w/submuc inj,A,,1.01,8.67,,0.72,,0.14,9.82,1.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
5,50445337,,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
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210