No office rate
Both codes describe endoscopic decompression of volvulus. Choose based on the documented scope: rigid proctosigmoidoscope for 45321, flexible sigmoidoscope for 45337.
On this page
CMS RVU26D · Effective 2026-10-01
45321 Volvulus decompression Medicare reimbursement rates in West Virginia
Reports rigid proctosigmoidoscopy used to decompress a volvulus, typically during urgent treatment of sigmoid twisting and obstruction. Compare 45321 office and facility rates across CMS payment localities in West 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 45321 in West Virginia?
West Virginia 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
No supported rate
Facility setting
$100.45
1 of 1 localities have a supported rate.
Payment area: West Virginia
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 45321: Rigid proctosigmoidoscopic volvulus decompression
Reports rigid proctosigmoidoscopy used to decompress a volvulus, typically during urgent treatment of sigmoid twisting and obstruction.
A clinician advances a rigid proctosigmoidoscope through the anus to reach the rectum and distal sigmoid, then relieves the distention caused by a volvulus. The service is generally performed by a gastroenterologist or colorectal surgeon in a hospital or other acute-care setting when endoscopic decompression is indicated. The code describes therapeutic decompression, not inspection alone; a flexible sigmoidoscope used for the same purpose belongs to a different code.
Select this code when the operative report supports use of a rigid scope and documents treatment of the volvulus by decompression. Record the indication, scope approach, and therapeutic 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 for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 45321
- 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 RVU1.61 · 55%
- Practice expense (office) RVU0.90 · 31%
- Malpractice RVU0.43 · 15%
20
Medicare services in 2024 · #5922 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.
45321 compared with similar codes
Office rates for West Virginia, from the same CMS release.
$135.02
45300 is diagnostic rigid proctosigmoidoscopy. Use 45321 when the rigid examination includes therapeutic decompression of a volvulus.
$192.76
45330 describes diagnostic flexible sigmoidoscopy. It does not represent therapeutic decompression of volvulus with a rigid scope.
Compare 45321 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
West Virginia →
Office / nonfacility
Unavailable
Facility
$100.45
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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 45321 in West Virginia.
PPRRVU2026_Oct_nonQPP.csv
5,496
- Code
- 45321
- Physician work
- 1.61
- Practice expense
- 0.90
- Malpractice
- 0.43
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.61 | × 1.000 | 1.6100 |
| Practice expense | 0.90 | × 0.869 | 0.7821 |
| Malpractice | 0.43 | × 1.431 | 0.6153 |
| Total RVUs | 3.0074 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, West Virginia$100.45
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.61 | 1 |
| Practice expense | 0.9 | 0.869 |
| Malpractice | 0.43 | 1.431 |
(1.61 × 1 + 0.9 × 0.869 + 0.43 × 1.431) × $33.4009 = $100.45
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.
45321 billing questions
How does this differ from flexible sigmoidoscopic decompression?
This code is for decompression performed with a rigid proctosigmoidoscope. Use the flexible sigmoidoscopy code when the documented approach is flexible.
Can diagnostic proctosigmoidoscopy be reported separately?
When diagnostic inspection is part of the same endoscopic session as therapeutic decompression, apply the endoscopy family pricing rules for related procedures. The record should distinguish any separate service before considering separate reporting.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports code selection?
Document the volvulus, the use of a rigid proctosigmoidoscope, and the decompression performed. The documented approach helps distinguish this service from flexible sigmoidoscopic decompression.
Does the code include same-day care, and can an assistant be billed?
The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service.
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.
5,49345315,,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
5,49545320,,Proctosigmoidoscopy ablate,A,,1.64,5.29,,0.91,,0.43,7.36,2.98,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49645321,,Proctosigmoidoscopy volvul,A,,1.61,0.90,NA,0.90,,0.43,2.94,2.94,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49745327,,Proctosigmoidoscopy w/stent,A,,1.85,0.96,NA,0.96,,0.48,3.29,3.29,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45300,33.4009,09,0,99,0.00,0.00,0.00
5,49845330,,Diagnostic sigmoidoscopy,A,,0.82,5.50,,0.67,,0.12,6.44,1.61,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,49945331,,Sigmoidoscopy and biopsy,A,,1.11,8.42,,0.75,,0.14,9.67,2.00,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45330,33.4009,09,0,99,0.00,0.00,0.00
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,