CPT 45305
Global 000 ActiveProctosigmoidoscopy w/bx
CPT 45305 Billing & Documentation Guide
CPT code 45305 (Proctosigmoidoscopy w/bx) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.12, a non-facility practice expense RVU of 4.62, and a malpractice RVU of 0.2, a total non-facility RVU of 5.94 and facility RVU of 2.07. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $204.94, though rates vary from $173.4 to $267.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45305, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 45305 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 45305 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 45305
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.12 | 1.12 |
| Practice Expense RVU | 4.62 | 0.75 |
| Malpractice RVU | 0.2 | 0.2 |
| Total RVU | 5.94 | 2.07 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45305
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $224.97 | $72.01 | $210.75 - $267.62 | 29 |
| Florida | $205.24 | $75.55 | $194.97 - $214.94 | 3 |
| Georgia | $192.68 | $69.36 | $183.02 - $202.33 | 2 |
| Illinois | $199.41 | $74.51 | $188.74 - $208.09 | 4 |
| Michigan | $191.71 | $70.34 | $185.84 - $197.58 | 2 |
| North Carolina | $185.65 | $65.05 | $185.65 - $185.65 | 1 |
| New York | $220.42 | $76.21 | $188.7 - $235.69 | 5 |
| Ohio | $185.03 | $67.01 | $185.03 - $185.03 | 1 |
| Pennsylvania | $196.04 | $69.43 | $185.38 - $206.69 | 2 |
| Texas | $195.74 | $68.48 | $184.04 - $206.66 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 45305
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45305 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0184T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 45305
What does CPT code 45305 mean? +
CPT code 45305 represents: Proctosigmoidoscopy w/bx. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45305? +
The 2026 Medicare national average non-facility payment for CPT 45305 is $204.94. Rates range from $173.4 to $267.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45305? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 45305? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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