Billing code 45305: ProctosigmoidoscopyMedicare rate & RVUs in Ohio
Reports rigid examination of the rectum and distal sigmoid with tissue sampling to evaluate abnormal mucosa, a lesion, or another finding.
Medicare pays $185.03 for 45305 in the office in Ohio (Ohio). 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 45305 covers
The clinician advances a rigid proctosigmoidoscope to inspect the rectum and distal sigmoid and takes one or more tissue samples during the examination. Common reasons include sampling abnormal mucosa, an ulcer, or a suspicious lesion. Gastroenterologists and colorectal surgeons may perform the procedure in an office or a facility-based endoscopy setting. The biopsy is part of this service; the code covers obtaining the sample, not the laboratory examination of the tissue.
Choose this code when the documented procedure uses a rigid scope and includes biopsy. A diagnostic rigid examination without biopsy is coded differently; a flexible sigmoidoscopy with biopsy is a different service. Record the scope type, examination performed, and biopsy site or sites. 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 for 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.
45305 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $185.03 | $67.01 |
How the 45305 rate is calculated
Each of 45305’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 · 45305
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.12Practice expense 4.62Malpractice 0.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45305
The CMS indicators that decide how 45305 is paid alongside other services.
CMS payment indicators · 45305
Proctosigmoidoscopy
| 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
45305 without 51 · national office
$198.40
Proctosigmoidoscopy
45305-51 · Second procedure: 50%
$99.20
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%).
45305 compared with similar codes
Compare codes
45305 vs 45300 vs 45331 vs 45308: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45300Proctosigmoidoscopy
- 45300 is the diagnostic rigid examination without biopsy. Report 45305 when tissue is sampled during the rigid examination.
- 45331Sigmoidoscopy
- 45331 describes biopsy during flexible sigmoidoscopy. Choose based on the scope used, not simply on the fact that tissue was sampled.
- 45308Lesion removal
- 45308 is for lesion removal by rigid proctosigmoidoscopy. Use 45305 when tissue is sampled rather than removed as a therapeutic lesion procedure.
45305 billing questions
How does this differ from 45300?
Use 45305 when the rigid proctosigmoidoscopy includes tissue sampling. Code 45300 describes the diagnostic rigid examination without biopsy.
Can I report this for a flexible sigmoidoscopy biopsy?
No. This code is for a rigid proctosigmoidoscopy with biopsy; 45331 is the corresponding flexible sigmoidoscopy biopsy service.
Is biopsy included in the procedure?
Yes. Obtaining the biopsy specimen is included in 45305. The tissue laboratory examination is a separate service when performed and reported by the appropriate laboratory provider.
Should modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this service, so do not use modifier 50.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document each service performed and do not assume each procedure receives independent full payment.
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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