CPT 45309
Global 000 ActiveProctosigmoidoscopy removal
CPT 45309 Billing & Documentation Guide
CPT code 45309 (Proctosigmoidoscopy removal) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.37, a non-facility practice expense RVU of 5.27, and a malpractice RVU of 0.37, a total non-facility RVU of 7.01 and facility RVU of 2.58. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $240.98, though rates vary from $203.33 to $311.24 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45309, 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 45309 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 45309 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 45309
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.37 | 1.37 |
| Practice Expense RVU | 5.27 | 0.84 |
| Malpractice RVU | 0.37 | 0.37 |
| Total RVU | 7.01 | 2.58 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45309
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 | $262.38 | $87.3 | $246.08 - $311.24 | 29 |
| Florida | $246.42 | $97.97 | $232.61 - $260.25 | 3 |
| Georgia | $228.54 | $87.38 | $217.5 - $239.58 | 2 |
| Illinois | $239.62 | $96.65 | $225.78 - $251.34 | 4 |
| Michigan | $228.44 | $89.5 | $220.42 - $236.46 | 2 |
| North Carolina | $217.89 | $79.83 | $217.89 - $217.89 | 1 |
| New York | $261.1 | $96.03 | $221.67 - $280.93 | 5 |
| Ohio | $218.93 | $83.83 | $218.93 - $218.93 | 1 |
| Pennsylvania | $231.8 | $86.86 | $219.03 - $244.57 | 2 |
| Texas | $230.78 | $85.11 | $217.42 - $243.03 | 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 45309
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45309 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 | CPT Manual or CMS manual coding instruction |
| 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 45309
What does CPT code 45309 mean? +
CPT code 45309 represents: Proctosigmoidoscopy removal. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45309? +
The 2026 Medicare national average non-facility payment for CPT 45309 is $240.98. Rates range from $203.33 to $311.24 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45309? +
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 45309? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team