$227.51–$269.34
Use 45308 when hot biopsy forceps or bipolar cautery removes the lesion. Use 45309 when a snare is used.
On this page
CMS RVU26D · Effective 2026-10-01
45308 Lesion removal Medicare reimbursement rates in Virginia
Reports removal of a distal rectal or rectosigmoid lesion during rigid proctosigmoidoscopy using hot biopsy forceps or bipolar cautery. Compare 45308 office and facility rates across CMS payment localities in Virginia.
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 45308 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$220.75–$261.53
2 of 2 localities have a supported rate.
Facility setting
$77.60–$89.99
2 of 2 localities have a supported rate.
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 45308: Rigid proctosigmoidoscopic lesion removal with cautery
Reports removal of a distal rectal or rectosigmoid lesion during rigid proctosigmoidoscopy using hot biopsy forceps or bipolar cautery.
A rigid proctosigmoidoscope is used to inspect the rectum and distal sigmoid and remove a tumor, polyp, or other lesion with hot biopsy forceps or bipolar cautery. Gastroenterologists and colorectal surgeons may perform the procedure in an office, endoscopy suite, or operating room. The operative note should identify the rigid scope, the lesion treated, and the removal technique; a diagnostic examination or tissue sampling alone does not establish this service.
Select this code for cautery removal, rather than snare removal or biopsy alone. 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 for this anatomy and service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 45308
- 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 RVU1.27 · 19%
- Practice expense (office) RVU5.18 · 76%
- Malpractice RVU0.35 · 5%
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.
45308 compared with similar codes
Office rates for Virginia, from the same CMS release.
$193.81–$228.64
45305 reports biopsy during rigid proctosigmoidoscopy; 45308 represents cautery removal of a lesion.
$360.64–$426.86
45333 is the flexible-scope counterpart for lesion removal by hot biopsy forceps or bipolar cautery. This code is for rigid proctosigmoidoscopy.
$210.80–$249.73
45330 is diagnostic flexible sigmoidoscopy. Choose 45308 when a lesion is removed with the specified cautery technique during rigid proctosigmoidoscopy.
Compare 45308 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$261.53
Facility
$89.99
Virginia →
Office / nonfacility
$220.75
Facility
$77.60
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45308 billing questions
How does this differ from 45309?
This code represents lesion removal with hot biopsy forceps or bipolar cautery. Code 45309 is the related rigid-scope option when the lesion is removed by snare.
Can I report this for a biopsy?
No. Biopsy without the described cautery removal is represented by 45305 for rigid proctosigmoidoscopy.
Can diagnostic endoscopy be separately reported with this service?
When related endoscopies are performed together, CMS endoscopy-family pricing applies. The procedure documentation should support the therapeutic service and any separately reported endoscopy.
Should modifier 50 be appended for multiple lesions or sides?
No. Modifier 50 is inappropriate for this service and anatomy; the CMS bilateral adjustment does not apply.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.
What is included in the 0-day global period?
Same-day preoperative and postoperative care is included. The global period is 0 days.
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.
5,48845303,,Proctosigmoidoscopy dilate,A,,1.37,29.10,,0.80,,0.23,30.70,2.40,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,48945305,,Proctosigmoidoscopy w/bx,A,,1.12,4.62,,0.75,,0.20,5.94,2.07,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49045307,,Proctosigmoidoscopy fb,A,,1.56,5.10,,0.89,,0.42,7.08,2.87,0,000,0.00,0.00,0.00,3,0,0,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49145308,,Proctosigmoidoscopy removal,A,,1.27,5.18,,0.82,,0.35,6.80,2.44,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49245309,,Proctosigmoidoscopy removal,A,,1.37,5.27,,0.84,,0.37,7.01,2.58,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49345315,,Proctosigmoidoscopy removal,A,,1.66,5.43,,0.91,,0.43,7.52,3.00,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49445317,,Proctosigmoidoscopy bleed,A,,1.85,5.04,,0.92,,0.30,7.19,3.07,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00